Draft Agenda

DRAFT AGENDA

COUNCIL MEETING DATE Thurs. June 6, 2019 SCHEDULED TIME 9:30am-3:45pm LOCATION Meissner Fishbein Room, Suite 5055, CASLPO

FACE-TO-FACE ✓

TELECONFERENCE

No SUBJECT DOC ACTION 1. Adoption of Agenda ✓ Decision

2. Declaration of conflict of interest Professional Member Elections 2019–Update & New Member 3. ✓ Introductions 4. Interim President’s Remarks

5. Approval of Council Minutes of March 1, 2019 ✓ Decision

6. Business arising from minutes Discussion

7. Evaluation Summary – March 1, 2019 Council Meeting ✓ Discussion Risk Management Report

8. ✓ Decision

Registrar’s Report 9.1 CAASPR update ✓ 9.1.1 CAASPR Registrars Report Information 9.1.2 Project Timelines 9.1.3 Letter to CAASPR from CASLPO Council Information 9. 9.2 FHRCO Update Information 9.2.1 Annual Highlights

9.2.2 Cayton Report

9.2.3 Grey Areas Report 9.3 25th Anniversary Activities Update

Break 10:45am – 11:00am

10. Election of Officers and Executive Committee ✓ Decision

11.1 Position Statement on Professional Boundaries ✓ Decision 11. 11.2 Sexual Abuse Prevention Program ✓ Decision 11.3 Appointments to ICRC Decision Lunch –12:00 – 1:00pm

12. Strategic Plan 2018-2021 Progress Report ✓ Information

13. Operational Plan ✓ Information Finance 14. ✓ Information 14.1 Second Quarter Financial Report

14.2 Reappointment of Auditors and Auditor Assessment Tool ✓ Decision

✓ Attachment Provided CASLPO•OAOO

15. 2017 – 2018 Annual Report (separate document on Box.com) ✓ Decision Break 2:30pm – 2:45pm Citizens Advisory Group Report re: CASLPO presentation 16. ✓ Information of May 4, 2019 17. MSAT Overview Presentation Information

18. Information Committee Reports *No Report **To Follow ✓ a) Executive ✓ b) Registration ✓ c) Quality Assurance ✓ d) ICRC - e) Discipline * ✓ f) Finance ✓ g) Practice Matters

h) Fitness to Practice* - i) Patient Relations ✓

19. Other Business 20. Meeting Duration Decision Adjournment Next meeting: September 27, 2019 Location: CASLPO Offices - Meissner Fishbein Room

✓ Attachment Provided CASLPO•OAOO

MEMORANDUM

SUBJECT: PROFESSIONAL MEMBER ELECTION: DISTRICT 6

TO Council

FROM Laura Bartolini DATE May 17, 2019 MEETING DATE June 6, 2019

INTRODUCTION

The election process for 2019 is now complete and a successful candidate has been elected in District 6 (Ontario at Large). Bob Kroll’s term ended at midnight on May 16th.

BACKGROUND

o The vendor BigPulse was contracted to manage the electronic election process o Nominations opened to all 4,072 eligible voters as per By-law 5.6, on March 4 o Nominations closed on April 2 resulting in 3 eligible nominations: ▪ Elissa Flagg (SLP) ▪ Peter Stelmacovich (AUD) ▪ Rex Banks (AUD) o Voting poll opened to eligible members on April 17 and closed on May 16 at midnight.

RESULTS

At the close of the polls at 2400h on May 16 the results were as follows: Candidate Number of Votes Percentage of Votes Elissa Flagg 305 41.16 Peter Stelmacovich 240 32.39 Rex Banks 196 26.45 Elissa Flagg, SLP, was determined as the successful candidate.

18.2% of eligible members voted.

Election 2020 The election for 2020 will include one SLP and one AUD each from District 1 and District 3 involving 4 positions in total.

CASLPO●OAOO Page 1 of 1 MINUTES DRAFT

COUNCIL MEETING

DATE Friday March 1, 2019 TIME 9:30am – 3:35pm

LOCATION CASLPO - Meissner Fishbein Room B. Kroll, President & Chair, J. Anderson, T. Barber, K. Bright, T. D’Agnillo, L. Ellwood, K. PARTICIPANTS Eskritt (TC), E. Fitzpatrick (TC-1/2 day), S. Singh Johal, R. Metras, P. Millett, D. Mooney (TC), M. Moussa-Elaraby, V. Vaillancourt, R. Penny, Y. Wyndham, S. Wilson

REGRETS None

OBSERVERS Andrej Sikic and Jenny Chau, MOHLTC B. O’Riordan, Registrar; C. Bock; A. Carling, R. Cimerman, STAFF S. Joglekar, C. Myrie, P. Singh, L. Bartolini (Scribe), L. Gibson No SUBJECT ACTION/MOTION 1. Adoption of Agenda MOTION: That Council At 9:35 am, B. Kroll welcomed Council members, guests from MOHLTC and staff. approve the meeting agenda as presented. Moved R. Penny Seconded L. Ellwood Carried 2. Declaration of Conflict of Interest None.

3. Approval of Council Minutes of January 18, 2019. MOTION: That Council Correction to item 18 - Fitness to Practice Committee to be revised to read “consider members be approve the minutes of appointed to other committees as needed”. Jan.18/19 as amended. Moved M. Moussa-Elaraby Seconded R. Metras Carried 4. Business Arising from minutes None. 5. President’s Remarks

B. Kroll shared a communication he received from a newer Council member who expressed gratitude and appreciation of the tremendous amount of good work CASLPO staff and Council do. Bob expressed his pride in the work Council has done in his 9 years as a Council member and 2

years as President. He commented on the unprecedented change going on around us and how Council members, non-Council members and staff have responded proactively to shifts in regulation, legislation and governance. A special expression of appreciation to the public members who participate fully and bring valuable insight and input to each and every meeting and to the professional and academic members who provide a wealth of experience and expertise in the governance of CASLPO. 6. Evaluation Summary of January 18, 2019 Council Meeting The President shared that the Executive Committee reviewed the previous Council meeting’s feedback and provided the following recommendations: • Encourage all Council members to make every effort to participate in-person to all meetings. If not possible, more participation from members joining during teleconference will be encouraged. • Members can bring water containers to refill from the sink instead of using disposable bottles. • Agenda items with a great deal of reading information will have a note where possible to direct members to areas of focus and provide questions for discussion. • Staff to focus on leading discussion for agenda items at meetings rather than presenting material included and read by members in their meeting preparation.

Draft CASLPO Council Meeting Minutes as at March 1, 2019; lb Approved by Council:

7. Registrar’s Report B. O’Riordan reported on operational items. 7.1 Operational Update

• Remediation work at CASLPO offices are coming to a conclusion

• Annual performance review goals for the Registrar were submitted to the Executive

Committee for review at their meeting on February 15

• 25th Anniversary launched with activities planned monthly throughout 2019. 7.2 Self-Assessment Tool Submission Report Alex Carling reported that all Academic and General Members of CASLPO were required to submit their online Self-Assessment Tool (SAT) by 11.59 pm. EST, January 31st, 2019 at which time all but 23 members were in compliance. All members were required to review the Code of Ethics with 3,594 members clickig on the document. This year, the Quality Assurance Committee decided on the Code of Ethics as the new requirement for the SAT. This decision comes from data collected throughout the year such as calls received and issues/trends. The 23 outstanding submissions by members were received with a letter of explanation by the March 8 deadline. The process of completing and submitting the 2019 SAT was a success. We are increasing the submission rates at every phase of the process. B. Kroll and B. O’Riordan congratulated A. Carling and her team on this huge accomplishment.

7.3 MSAT Pilot (Mentor Self-Assessment Tool) Samidha Joglekar, Audiology Advisor & Manager of Mentorship, reported that in November, 2018, eight professional members participated in a MSAT pilot conducted at the CASLPO offices. Participants were from both professions who had recently been either a mentor or mentee. The objective was to have members test the usability of the MSAT and provide feedback including adjustments to the MSAT and a revised Mentorship Guide. Additional revised documents will be made available to members in coordination with the launch of the MSAT that is anticipated to be later in 2019. C. Bock congratulated Samidha on the development of this very sophisticated tool. 7.4 Practice Advice Report Alex Carling reported on the Annual Comparison of practice advice contacts for 2018. The number of members and other professionals contacting the College by phone or email continues to increase. There was a spike of calls from the public in 2017 as a publicly funded audiology department was closed and all the patients were told to contact the College to find alternative services. This, in part, could account for the decrease in calls from the public in 2018. Staff from Professional Practice and Professional Conduct are meeting to align data collection categories and to ensure that the data provides meaningful information. Noted the vast majority of calls from the public are how to find an Audiologist or Speech- Language Pathologist. Hits on areas of the website are also tracked. Calls received also include those from the public re: comments/complaints, other colleges, Ministry calls, etc. A. Carling and S. Joglekar recently hosted a booth at the Canadian Academy of Audiology Conference and spoke with as many Ontarians as possible to engage in information sharing. These communications are not reflected in the statistics. We will also have a booth at the 2019 SAC conference to encourage further engagement of our members. 8. CNO Vision 2020 Based on the review of feedback received in the survey by Council members following the January Council meeting, the Executive Committee is recommending that CASLPO provide a letter of response to the College of Nurses of Ontario. Although there is the option of providing no response, the Committee thinks a lack of response could be interpreted in many, varied ways and that it is prudent to avoid misinterpretation. The Committee recommends that the response addresses:

1. Common goals that CASLPO and CNO have with regard to always striving to improve

protection of the public

2. The degree to which the proposed governance changes address CASLPO needs

Draft CASLPO Council Meeting Minutes as at March 1, 2019; lb Approved by Council:

3. Concerns regarding the implementation of some facets, such as the separation of the Council from the Statutory Committees.

B. O’Riordan provided background on why the CNO developed a new governance model.

Noted in discussion:

• Some processes were not outlined in the information provided by CNO i.e. who would

appoint members?

• The Ministry has not formally asked colleges for their input

• Agreement by members was that CASLPO is not in the situation of its governance model “needing fixing” • Competency-based appointment of public members may not work for our College also noting the government screens public member applications thoroughly • As we represent 2 professions, 18 Council members is appropriate and it is in full agreement that reducing our Council membership to 12 would not represent the public’s interest to the fullest • Not having Council members sit on statutory committees as proposed by CNO’s governance model would not work well for our College as there would be a gap in information sharing and understanding of processes. M: CASLPO will respond • Compensation for public and professional members had varying opinions to CNO after a letter is • The mix of public and professional members seems very balanced currently finalized with Council and It was unanimously agreed that we will respond to CNO and applaud them in their work. Taking Executive input. this opportunity to reflect on our own governance, as a group, our structure and the way we operate shows we are mostly satisfied and that we are comfortable. Staff have enough information to draft a letter which will be sent to all Council members for input and finalized with the Executive Committee on March 18. Moved S. Singh Seconded V. Valliancourt Carried 9. CAASPR Update M: Council to approve B. O’Riordan reported on the current state of issues with CAASPR. There is continuing opposition holding the meeting of the from the BC and Alberta regulatory colleges to participating in the centralization of the National Executive Committee on Exam Application Process and in the national assessment of internationally-educated applicants. March 18 to focus mainly The exam vendor, SAC, has indicated they will not contract individually with provinces. on CAASPR issues and Executive Committee met on February 15th and will discuss further steps at a meeting of the recommendations for Committee on March 18, if approved. resolution. Council agreed that due to the amount of information and discussion/decision-making needed, A: The Executive the Executive decision is the most effective way to provide input and approval within a very tight Committee will meet to timeline. finalize recommendations to put forward to CAASPR in order to resolve the issues as noted. Moved P. Millett Seconded R. Penny Carried 10. Quality Assurance M: That Council approve 10.1 Clinical Reasoning Tool the Clinical Reasoning Alex Carling reported that the Clinical Reasoning Tool (CRT) underwent an effectiveness Tool as presented. study in 2017. The CRT was administered in an authentic setting (peer assessment) and the methods used to measure effectiveness were: • Validity study • Inter-rater reliability • Calibration exercise The Clinical Remediation Program discussion goes to the QA Committee on March 4. This adds an additional level in public protection. Noted, if there is a member lacking in clinical reasoning, a conversation from another peer assessor in their area can take place for additional input. Council expressed enthusiasm for this new tool in providing motivation and stimulus for members to acknowledge the need for change in behaviours where needed.

Draft CASLPO Council Meeting Minutes as at March 1, 2019; lb Approved by Council:

Our tool is quite unique, and we anticipate it will promote further interest from other colleges. This will be rolled out and available to the entire membership along with the guide, upon approval, and will be integrated with the SAT in the future. An e-forum will be held to inform members. The requirement is that all members participating in peer assessment must complete the tool. Moved K. Eskritt Seconded R. Metras Carried 10.2 Standards Working Group M: Council to approve the C. Bock provided an overview of the process for revising standards including structure, recommendations of the identifying priorities and timelines and decision-making principles. Council was Standards Working Group enthusiastic about the process. as presented. Moved V. Vaillancourt Seconded R. Penny Carried 11. Strategic Plan 2018-2021 C. Bock updated Council on activities on the Strategic Plan, noting all priorities are on track to date. 12. First Quarter Financial Report R. Cimerman reported there are currently expenses, larger than expected, for professional fees and consultants, which will be reflected in future quarterly reports. There were no concerns. 13. Registration Regulation M: That Council approves The MOHLTC is required to post draft regulations that could affect Ontario businesses to the Regulatory Registry website for comment by the general public for 45 days. The College has the draft Registration submitted a draft of our amended Registration Regulation to the MOHLTC along with a Regulation in principle for Regulatory Impact Report (as requested by the Ministry). The Ministry is currently working submission to the Ministry through the regulatory impact analysis before posting our draft registration regulation on the of Health and Long-Term registry website. To avoid further delays, the College would like to proceed with approval of the Care. draft regulation in principle so that we may move forward with our preparation of the submission to the MOHLTC assuming we do not receive any significant feedback from the Regulatory Registry circulation. This assumption is based on previous experience posting our regulation amendments on the registry. Moved M. Moussa-Elaraby Seconded V. Vaillancourt Carried 14. Nominations for Recognition of Outstanding Achievements M: That Council approve that the successful The Executive Committee reviewed the nomination submitted for Outstanding Contributions recipient for Outstanding Award/Recognition for a professional member, and recommend that Council approve that Vicky Contributions for a Papaioannou be the recipient of the award for 2019. Professional, is Vicky Papaioannou. M: B. Kroll will notify V. Papaioannou in March. Moved S. Wilson Seconded S. Singh Carried 15. Conflict of Interest Standards (COI) M: Council approved the P. Singh provided an overview of the overwhelmingly positive ratings and feedback received as a publication of the Conflict result of the consultation of members of CASLPO, FHRCO, associations and CAASPR regarding of Interest Standard. the need for revision of the COI Standard. Very few changes were made to the draft COI. However, some revisions were made to Standard 3 to improve clarity. FAQs will be developed 6-12 months after the release of the COI, to determine what areas of the document would benefit from FAQs. Moved R. Metras Seconded S. Wilson Carried 16. Council Education Day M: That Council approve We have been successful in securing Deanna Williams, who has presented to Council in the past, securing the speakers for and Shenda Tenchak on governance priorities for change. Richard Steinecke will present on Education Day as regulatory governance moving forward. presented. Moved M. Moussa-Elaraby Seconded Y. Wyndham Carried 17. Proposed By-law Revisions - No. 1 - Vice-Presidents – proposed changes M: That Council approve P. Singh provided the overview of the proposed changes reducing the Vice-President position the changes to By-law #1 from two currently, to one. With the proposed changes, public members will be able to hold a as presented to take effect VP role. The changes would take effect on June 6th prior to the election of Executive Committee. June 6, 2019. Moved J. Anderson Seconded T. Barber Carried

Draft CASLPO Council Meeting Minutes as at March 1, 2019; lb Approved by Council:

18. Committee Reports 18a) Executive Committee – No further discussion 18b) Registration –It was asked if we can provide timelines around metrics. C. Bock reported we can provide a link to the guidelines which show those. Time sensitive issues continue to be brought forward between meetings. 18c) Quality Assurance – No comments 18d) ICRC - What mechanisms are in place to filter complaints so that staff are not inundated at any one time. P. Singh reported that, there is not authority in the RHPA which exempts the College from investigating the complaints, especially when it relates to a violation of College regulations. However, CASLPO is currently recruiting a Case Manager to take carriage of these cases, in recognition of unprecedented work load this influx has caused. 18e) Discipline – No comments 18f) Finance – No meeting 18g) Practice Matters – No meeting – the inaugural meeting will be set shortly which was pending the approval of the recommendations by the Standards Working Group. 18h) Fitness to Practice – No meeting 18i) Patient Relations – Tara to be added to the report (bottom) 19. Other Business B. O’Riordan, on behalf of staff, Council Members and non-Council members, thanked B. Kroll for his outstanding leadership and service to CASLPO and Council over the last 9 years. His work in Ontario and nationally, is so much appreciated. We congratulate Bob on all of his successes, and will honour him more formally in the future. 20. Meeting Duration

9:35am – 2:50 pm Adjournment The meeting adjourned at 2:50 pm

The next Council meeting will be held on Thursday, June 6, 2019.

Draft CASLPO Council Meeting Minutes as at March 1, 2019; lb Approved by Council:

MEMORANDUM SUBJECT: COUNCIL MEETING SURVEY RESULTS

TO Council

FROM Laura Bartolini DATE April 11, 2019 MEETING DATE June 6, 2019

Survey completed by 14/16 meeting participants

ACTION REQUESTED Review the results of the March 1, 2019 Council meeting survey and put forward any recommendations by the Executive Committee to Council.

SURVEY ANALYSIS Q 1 – Members had the opportunity to actively participate in discussions and decision-making processes. - 100% respondents said YES • No additional comments Q 2 – The Council moved efficiently through the agenda - 100% said YES • No additional comments Q 3 – Any additional comments regarding the meeting process? • I thought Bob did a great job keeping track of everyone who wanted to speak (and there was a lot of discussion so a lot of people speaking!!). I also thought the suggestion of a regular check in with people o the phone was a great idea that we should continue. • New microphones work fine • The agenda moved along quite well • I am really going to miss Bob. From the time I became a Non-Council member to the present time… Bob has been around. He has been a great educator to myself and I really admire and respect his contribution to the SLP world and to CASLPO. I will definitely miss seeing I’m and enjoying his CASLPO presence. • Thank you for listening to our comments and acquiring new microphones • Like the attempt to make participation easier for those o the phone.

Q 4 – Council acted with an emphasis on strategic leadership rather than administrative details. - 100% of respondents said YES. • Absolutely. We were all business today! • Staff keep us from straying into operational details.

Q 5 – The Council considered the strategic plan when making decisions regarding policies and projects? - 100% of respondents said YES. • No additional comments Q 6 –Any additional comments regarding governance? • none

CASLPO●OAOO Page 1 of 2 Q 7 –I communicated effectively and respectfully. – 100% said YES. • I was on phone, the hearing quality was considerably better with the new microphones, although some start with strong voices and end with much softer tones. Q 8 – I was prepared for the meeting? 100% said YES. • No additional comments. Q 9 – Any additional comments regarding my contribution at Council meetings? • I felt like I had a better handle on the topics this meeting and felt like I could contribute more by asking questions and commenting. Maybe too many questions?

RECOMMENDATIONS TO COUNCIL

Feedback was excellent. No recommendations at this time.

CASLPO●OAOO Page 2 of 2 MEMORANDUM

RISK MANAGEMENT ANNUAL REVIEW TO Council FROM Ruth Cimerman, Director of Finance and Operations

DATE May 30, 2019 MEETING DATE June 6, 2019

ACTION REQUESTED Approve the Risk Policy, Risk Tolerance Profile and risk mitigation priorities identified by the Finance Committee at their May 14, 2019 meeting.

BACKGROUND The Finance Committee met on May 14, 2019 to perform their annual review of CASLPO’s Risk Policy, Risk Tolerance Profile, Risk Register and Fraud Risk Reassessment Checklist. The Committee completed their review of the Risk Policy and Risk Tolerance Profile and recommended a few amendments. The Committee recommends that Council approve both amended documents. The Committee reviewed the Risk Register and determined that Council should focus their review on the areas that pose the highest risk and require prioritized mitigation. These selected risks have been included in Appendix 1 of the Risk Tolerance Profile. The Committee reviewed the Fraud Risk Reassessment Checklist and determined that there was one risk area that needed to be prioritized. This risk has been included in Appendix 2 of the Risk Tolerance Profile.

Documents included in the Risk Management Annual Review 1. Risk Policy – For approval 2. Risk Tolerance Profile (includes Appendix 1 – Prioritized risks from the Risk Register and Appendix 2 – Prioritized risk from the Fraud Risk Reassessment Checklist) – For approval Note: Complete copies of the Risk Register and Fraud Risk Reassessment Checklist are provided only as reference documents for Council. Staff will be focussing on the risk items in Appendix 1 and 2 included with the Risk Tolerance Profile for the Council meeting on June 6, 2019.

CASLPO●OAOO Page 1 of 1 COLLEGE OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS OF ONTARIO (CASLPO)

RISK POLICY Section 1 Introduction 1.1 An important aspect of governance and management best practices is to ensure that organizational risks are identified, assessed and managed in a timely, efficient and effective manner. CASLPO believes this Risk Policy is an integral step in the continuing evolution of the strategic planning process for the organization.

Section 2 Risk Management Vision 2.1 CASLPO is committed to building and fostering an enterprise risk management culture that clearly faces reality through the systematic process of risk identification, assessment and management and will affect this through its strategic planning process.

2.2 CASLPO’s values of serving and protecting the public interest, providing quality service, accountability and transparency, acting with integrity, teamwork and collaboration are the foundation of the organizational risk culture and will guide our actions.

Section 3 Risk Management Policy 3.1 Overall Policy: To accomplish our Mission, CASLPO must pursue opportunities, provide services and conduct activities which may pose degrees of external and/or internal risk. Accordingly, CASLPO’s policy is to apply an enterprise risk management framework with clear roles and responsibilities in the identification and management of risk, and to ensure that effective management of risk is an enterprise core competency.

CASLPO will identify and manage risks relevant to the organization within the context of its three year strategic plan, annual operational plan and budget and work closely with the Council/Committees (particularly Finance and Executive) to identify and manage risks relevant to CASLPO itself and the professions of audiology and speech-language pathology as a whole.

3.2 Risk Tolerance: CASLPO accepts a level of risk in many of the activities it undertakes. As part of its risk management process, CASLPO assesses its willingness to accept risk in various key operational elements. Guided by its vision, mission, mandate and values, CASLPO seeks to manage those risks to an acceptable level, otherwise referred to as its tolerance for risk.

CASLPO has developed a Risk Tolerance Profile, which will be updated annually to provide a high level view of the risk CASLPO is willing to accept related to CASLPO’s areas of responsibility. Specifically, the profile sets boundary conditions for risk tolerance, outlines the continuum of risk tolerances by which risks are assessed and provides CASLPO’s agreed level of risk tolerance for each element considered. 3.3 Enterprise Risk Management (ERM): is an integral part of strategic planning and ensures a uniform approach across the organization, including management and staff, council and committees for: ● risk identification ● risk assessment ● risk mitigation and management ● risk reporting and communications

ERM is not merely a defensive process to guard against “worst case” scenarios; it also: ● enables innovation and initiative in strategic planning ● serves to ensure successful implementation of strategic objectives ● enables proactive leadership focus and shaping of issues rather than reaction to events

3.4 Strategic and Operational Planning: CASLPO’s Strategic Plan provides a perspective of the dynamic, continuous, multi-year planning processes. It ensures that the strategic direction is sound, provides linkage between strategies and provision of services, and establishes the basis of the annual operational commitments and related budgets.

It is through CASLPO’s strategic and operational planning processes that key risks affecting the organization as a whole will be identified and addressed going forward. The ERM approach ensures systematic consideration of risk in the strategic and operational planning processes. It will also ensure that resource allocation explicitly takes into account risk mitigation efforts.

3.5 Roles and Responsibilities: 3.5.1 CASLPO Council: Council is responsible for the approval of CASLPO’s strategic plan (every three years) and operational plan/budget (annually), which will include CASLPO’s Risk Tolerance Profile. The Council, through the Finance and Executive Committees, will be responsible for oversight of ERM as it relates to CASLPO activities. 3.5.2 CASLPO Management: Management will provide operational leadership in the implementation of this risk policy in conjunction with its responsibilities for the strategic and operational planning processes, including resource allocation, budget development and recommendations. Their responsibilities include:

● Developing the risk tolerance profile as outlined above in Section 3.2.

● Identifying potential and emerging risks and assessing their likelihood/consequence as part of the strategic and business planning processes.

● Identifying those risks they determine are not acceptable and for which risk mitigation and management strategies must be developed.

● Determining the right level of risk for each strategic initiative utilizing the risk tolerance profile.

● Assigning responsibility to appropriate staff and committees to develop risk mitigation approaches/actions on an issue-specific basis.

● Explicitly identifying risk mitigation resource requirements and resultant resource allocation to manage risks to an acceptable level.

● Identifying opportunities to seize the initiative in managing the uncertainties of potential and emerging risks and outcomes.

● Implementing a process for tracking and reporting risks.

3.6 CASLPO’s Risk Culture: Risk management will be achieved through the development of an organizational culture where the common-sense consideration of risk is instinctive in normal day to day activities. Accordingly, ERM will be integrated into normal management processes, such as strategic and operations planning, project and operations management, and management reporting.

Creating a reality-based ERM culture also requires an atmosphere that encourages clear and candid discussion of risks among and across all levels of the organization without fear of judgment or consequences. CASLPO is committed to fostering that kind of environment.

3.7 Risk Policy Review: This policy will be reviewed annually by CASLPO Council to ensure its completeness, continued relevance and effectiveness.

Approved: June 12, 2015 Reviewed: June 10, 2016 June 9, 2017 June 8, 2018

COLLEGE OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS OF ONTARIO (CASLPO)

RISK TOLERANCE PROFILE

Section 1 Introduction CASLPO’s overall policy in relation to risk management is defined in the CASLPO Risk Policy: To accomplish our Mission, CASLPO must pursue opportunities, provide services and conduct activities which may pose degrees of external and/or internal risk. Accordingly, CASLPO’s policy is to apply an enterprise risk management framework with clear roles and responsibilities in the identification and management of risk, and to ensure that effective management of risk is an enterprise core competency.

To that end, CASLPO will identify and manage risks relevant to the organization within the context of its annual operational plan and three year strategic plan. In general, the plans describe the projects an organization plans to execute, the planned objectives and resources necessary to meet those objectives, and metrics to measure the organization’s success against those objectives.

The risks defined in this document were identified through consideration of the existing environment in light of CASLPO’s strategic plan objectives, budget and internal financial controls and policy development process.

Some of the specific factors and potential obstacles in mitigating risks are within CASLPO’s span of control (delivery of services, planning, communication) but many are not (external events, member actions, regulatory initiatives by government or other Colleges). However, even these can be anticipated, monitored and influenced by CASLPO, to varying degrees.

Section 2 Purpose CASLPO’s Risk Tolerance Profile has been developed as an internal tool for use by the organization in setting, tracking, and reporting on its strategies and activities. The Risk Tolerance Profile identifies, organizes and explains the risks CASLPO faces and links these to the organization’s strategies and actions. The profile is an integral part of CASLPO’s annual operational planning exercise.

The areas of risk identified are reflected in two general categories: • Enterprise Risk o Legal/ Regulatory o Core business o Supporting processes o Strategic

Key prioritized Enterprise Risks identified by the Finance Committee from the Risk Register are included in Appendix 1.

• Fraud Risk o Misappropriation of assets o Fraudulent financial reporting

Samples of Fraud Risks from the Fraud Risk Assessment Checklist are included in Appendix 2.

Section 3 Integrated Accountability The model illustrated below integrates risk management, performance measurement, strategic planning, and the operational planning and budgeting processes at CASLPO. The model also identifies the relationships between and among key governance and management processes. Risk assessment and any treatments identified helps to inform the operational planning and budgeting process and subsequently operational performance objectives for the next year. Integration of performance indicators and metrics will also enable monitoring of progress in mitigating risks.

Enterprise External Risk Influences Management

Strategic Annual Planning Governance Performance Scorecard

Execution of Budgets Annually

Section 4 Reporting CASLPO’s Risk Policy sets forth the guidelines for formal reporting against these risks and how their mitigation relates to and supports CASLPO’s strategic objectives. Definitions of the likelihood, impact, and overall risk tolerance level are clarified below:

Likelihood Qualitative Assessment Relative to Frequency of Occurring Probability Assessment of Occurring Rare (1) Extremely rare (once every 10 years). 0 -5% Unlikely (2) Has happened rarely. 6 -15% Moderate (3) Has happened periodically. 15-49% Likely (4) Has happened previously and could reasonably occur again. 50-79%

Almost Certain (5) Extremely likely to occur; at least annually. 80-100%

Impact Dimension Insignificant Minor Moderate Major Catastrophic (1) (2) (3) (4) (5) Stakeholders One Several Several Many stakeholders All stakeholders (reputation) stakeholder stakeholders stakeholders and public raise including the Note: stakeholders raises raise concerns and public concerns public lose may include concerns raise concerns confidence in government, CASLPO and/or members, associations, the professions in universities the long term Other Business Issue easily Issue requires Moderate Council needs to CASLPO cannot Objectives: absorbed in minor work needed approve budget recover Internal day to day adjustment to to adjustments to deal operational Processes & operations day to day accommodate with the issue capacity and Enablers operating issues. ceases to operate policies. Does Requires not require Council immediate notification. Council notification. Financial Less than 1% 1-10% of 11-40% of 41-100% of annual CASLPO is of annual annual expense annual expense budget or insolvent. expense budget. expense Equivalent to budget (approx. $30K- budget. operating reserves. (approx.<$30 $300K) (approx. (approx.>$1.25M- K) >$300K- $3.1M) $1.25M) Note: The impact of a risk may affect multiple Dimensions and should be considered on a case by case basis. Therefore, judgement must be used to determine where the overall impact lies. Overall Risk Tolerance Zero Risk A potential negative event, incident, circumstance, or outcome in which CASLPO Tolerance would be unwilling to accept any risk of occurrence at all; the Impact of which would be Catastrophic to the organization or the professions as a whole no matter what the Likelihood of occurrence. Example: Loss of confidential information from our server due to a security breach. Low Risk Risks assessed to have a Moderate to Almost Certain Likelihood and Major to Tolerance Catastrophic Impact are at the Low Risk Tolerance Level. Such risks shall require in all circumstances, risk mitigation assignment by CASLPO to appropriate staff and/or committees, action plans and tracking. The expected result of mitigation efforts is to reduce either the likelihood or the impact of risks initially assessed to be in this category. Example: Registration standards do not always certify competent professionals Moderate Risks assessed to have a Moderate to Almost certain Likelihood and Moderate Risk Impact or Rare to Unlikely Likelihood and Major to Catastrophic Impact are at the Tolerance Moderate Risk Tolerance Level. Such risks shall selectively receive mitigation assignment by CASLPO, but all will be tracked. Example: Inability to deliver reliable, relevant, accurate, accessible and timely information for members or public. High Risk Risks assessed to have a Rare to Moderate Likelihood and Insignificant to Minor Tolerance Impact are at the High Risk Tolerance Level. Risks assessed by CASLPO to be in this category will be monitored, reviewed, and re-assessed annually by CASLPO. Example: Failure to identity and incorporate technological advances in computer hardware.

Approved: June 12, 2015 Reviewed: June 10, 2016 June 9, 2017 June 8, 2018 Amended: June 10, 2016 June 9, 2017 June 8, 2018

APPENDIX A

CASLPO Risk Register Excerpts for Council May 2019

Risk Rating Risk Tolerance

Likelihood: Zero 1=Rare; Impact: 2=Unlikely; 1=Insignificant; Low 3=Moderate; 2=Minor; Moderate Responsible 4=Likely; 3=Moderate; Risk Risk Group/ 5=Almost 4=Major; Current Treatment/ Sector Category Description of Risk Event/Situation/Outcome Department Certain 5=Catastrophic High Link to Strategic Objectives and Mitigation Additional Treatment Necessary 1 C. C.8 Data security and integrity. BO/BF 2 5 Zero -Portal and servers are protected by firewalls and security certificates *SQL server upgrade will be completed in May 2019 Supporting Technology -Portal passwords are encrypted and a verification process exists for resetting passwords *By June 2019, take steps to enhance file network security Processes -External website is not connected to the internal domain through: -Data from local computers is backed to the server twice a day -implement a network structure to address user roles and -If main server fails, the redundant server is a mirror image and will be enabled automatically. Offsite backups permissions for the network drives to prevent unauthorized are performed twice daily. access, changes or deletions to documents -External contractors service/maintain servers - maintain security patches, anti virus, user management, backup -add 2 factor authentication for BOX processes *Investigate the cost of document management softwares and -Security updates for servers provided by Microsoft are up to date their ability to enhance data security and integrity -Exchange server for email moved to the Cloud in May 2018. This change adds consistency among users, resolves issues related to data sharing, reduces downtime as internet issues will not affect email and improves security and spam filtering. -A new policy was instituted in January 2019 whereby staff are now required to change their login password every 6 months 2 C. C.8 Risk of major security failures leading to theft or loss of BO/BF 2 5 Zero -See above re: data security and integrity mitigation (#1) *By end of September 2019, CASLPO will contract an external Supporting Technology confidential data, embarrassing leaks or inability to meet -CASLPO secures personal information from unauthorized access, use or disclosure. CASLPO secures the company to perform a security audit to review security policies Processes statutory requirements, or misuse of member information. personally identifiable information on computer servers in a controlled, secure environment, protected from and procedures, test security protocols and test susceptibility to unauthorized access, use or disclosure. When personal information is transmitted to other websites, it is security failures ~CASLPO server side is secure. Highest likelihood of protected through the use of encryption, such as the Secure Socket Layer (SSL) protocol, and transferred using *Complete staff and Council training will be completed by security failure is through user desktops and devices. an FTP site. September 2019. The training should focus on new security -Member personal information is not transmitted to E-Health and HPDB. Non-identifying information (i.e. protocols and address best security practices in and out of the practice location, residential region and postal code and amalgamated statistical data) is transmitted office and across devices

3 C. C.8a Risk of major disaster (e.g. building fire etc.) and our BO/BF/RC 2 5 Zero -Network files can be accessed externally through VPN if servers are intact *See above (#1&2) Supporting Business ability to recover and maintain our operations. -If servers are destroyed, internal data can be accessed from backup *Disaster Recovery Plan is currently being revisited in light of Processes Continuity -Database can be accessed through an SQL server the outcomes of the flood in November 2018. The review of the Planning plan will be completed by August 2019 and communicated to staff by September 2019. 6 A. Legal/ A.3 Increased standards and regulations to address public BO/CB 4 4 Low -Actively communicate and participate with FHRCO, CAASPR, OSLA, SAC and other regulated health colleges to *Currently, CASLPO has 3 regulation changes that have been Regulatory Other Laws & confidence. stay abreast of proposed changes and best practises submitted to the Ministry but have not been approved. These Regulations -Stay involved with current proposed changes and provide feedback to affect change - All papers circulated for proposals are: Advertising and Professional Misconduct ^The timing of new standards and regulations are comment by stakeholders, other regulated health colleges and the government are received by or forwarded to (proposed in 2013) and Registration (2019). Additionally, OSLA unpredictable the Deputy Registrar (DR). The DR determines whether a response is warranted by CASLPO and who the has submitted a proposal for Changes in Scope of Practice for ^Reports like the "Cayton Report" suggest that self- appropriate staff member is to craft the response. This process ensures that CASLPO mitigates the risk of SLP's and AUD's. regulation in the current form needs to be overhauled and missing a proposed change in regulation that may affect our members and provides CASLPO with an opportunity *Due to the unpredictable timing of enactment, CASLPO has not new legislation needs to be passed to replace the current to provide feedback with respect to the College's position on the proposed change budgeted for these activities. Rather, CASLPO will determine, at legislation which was written 30 years ago -Developed a process to bring proposed changes in the Strategic Plan to Council based on competing external a high level, what activities need to be completed to factors. The process involves identifying the scope of the project to address the external pressure, the risks of operationalize the changes (determine who does what) once the not completing the project, the cost and human resources necessary to complete the work and the work that will proposals are enacted. have to be deferred/reassigned in order to complete the new project. This approach ensures that Council has the ability to enact new standards and regulation with consideration to our Strategic Plan. -Bill 87 introduced a number of changes with respect to transparency and professional conduct processes related to sexual abuse cases. Changes have been implemented by CASLPO. The government also granted itself new powers to intervene in College operations. The future impacts of this power are unknown.

Page 1 of 4 CASLPO Risk Register Excerpts for Council May 2019

Risk Rating Risk Tolerance

Likelihood: Zero 1=Rare; Impact: 2=Unlikely; 1=Insignificant; Low 3=Moderate; 2=Minor; Moderate Responsible 4=Likely; 3=Moderate; Risk Risk Group/ 5=Almost 4=Major; Current Treatment/ Sector Category Description of Risk Event/Situation/Outcome Department Certain 5=Catastrophic High Link to Strategic Objectives and Mitigation Additional Treatment Necessary 7 B. Core B.2 Failure to certify competent professionals. BO/CM 2 4 Low -Rigorous registration & certification process *By the end of July 2019, host a webinar with Mentors which Business Certification - applicants must have a Masters from an accredited university or must have verified sufficient coursework focuses on FAQ's and basics of the mentorship program. Processes and practicum hours to meet core competencies (currently the split of Cdn vs Int'l applicants is 45/55) Following the webinar, attendees will be surveyed on future - prior to certification, applicants must go through a mentorship program or provide evidence of practise hours training needs of mentors. - Staff and Registration committee evaluate all applications which do not clearly meet the registration *By the end of August 2019, CASLPO will recruit a group of requirements mentors to engage in a focus group to inform us on how the -In 2017, a new resource (Audiology Advisor and Manager of Mentorship) was hired to enhance the Mentorship following processes will be implemented in 2019-20: program. -Mentor training -In 2018, CASLPO piloted the Mentorship Self Assessment Tool (MSAT). This tool will help standardize the -Integration of the Clinical Reasoning Tool (CRT) in the assessment of mentees, enable data collection across all mentorships and provide CASLPO with tools to improve mentorship process tracking and oversight of the process. The MSAT will be launched by September 2019. *Establish communication with employers to determine their -In May 2018, CAASPR completed an entry-to-practice competency review and approved a standardized entry-to- needs with respect to knowledge about CASLPO's registration practice core competency framework that will be implemented across Canada by 2020. CAASPR brought process, mentorship and their reporting obligations. By together professional members, Associations and Universities from all provinces to work together to produce September 2019, create a database of employers and establish competencies that meet the standards and are relevant in the marketplace. In order to implement the changes, communication channels. In 2019-20, begin outreach to registration regulations are currently being drafted. employers. *A competency based exam is being developed by CAASPR for implementation by Fall 2020. Passing the exam will be a requirement for registration by all applicants. This exam will provide additional assurance that competent professionals are being registered.

9 B. Core B.4 Quality Assurance / SAT / Peer Assessment are not BO/AC 2 4 Low -The Self-Assessment Tool (SAT) is a reflective instrument designed to allow members to measure whether they *In 2019, the Quality Assurance Committee will consider the Business Professional effective tools for ensuring that members are meeting the are meeting all standards and identify opportunities for growth and change. Self-directed learning methodology amount of increase in the annual overall number of peer Processes Learning standards of practice. is effective in adult learning and supported by research. assessments. Development -SMART goal methodology required for SAT - Peer assessors review SMART goals with members *Other Colleges peer assess 1 in 5 members. Some are able to ^Currently the number of peer assessments performed -Members are required to have 15 hours/year of professional development that directly relate to their learning do this using various degrees of peer assessment (i.e. A larger annually as a percentage of total members is the second goals and field of practise. Our members have 18 hours/year on average. portion of the membership participates in a 'lite' version of peer lowest of all Regulatory Health Colleges (1.3%). The -Annually, approximately 50 members are selected at random for Peer Assessment ( approx. <1% of total assessment similar to our non-clinical assessment. Based on the substantial cost to perform a peer assessment with a site member population) . Research shows that the good effects from being peer assessed last longer than 5 years. outcome, they could be referred for a full peer assessment visit ($1,000 per assessment on average) and the amount -The number of Peer Assessments performed will be increasing over time to more closely align with other including a site visit). The Quality Assurance will consider this of staff time to administer the program continues to be an regulatory Colleges option in conjuction with the recommended increase in the obstacle with increasing the overall number. -Peer assessment is based on the SAT, so that members are objectively evaluated on the same standards that overall number of assessments. ^On average, 15-17% of members who are peer assessed they used to assess themselves. Assessments provide objective feedback on member practices. *Through the 2018-2021 strategic plan, the Quality Assurance are not meeting the standards. In 2018, QA committee -Peer assessors are required to have been previously peer assessed and go through rigorous training provided by Committee will review recommendations based on research issued 1 SCERP to address deficiencies in supervision of the College gathered by staff relating to changes in the selection of peer support personnel, record keeping and seeking feedback -The Clinical Reasoning Tool (CRT) was rolled out widely in 2018. The Quality Assurance Committee has assessments which are based on risk rather than random from others in the profession. In general, SCERPs order developed an onsite remediation framework and education tools to support the process if the member is found to selection. members to complete a number of activities ranging from have insufficient clinical reasoning. Research supports the approach of immediate remediation as the most *All mitigation approaches listed above will be analyzed reviewing the relevant guides related to their deficiencies, effective catalyst for changing a member's behaviour. separately and in tandem to determine the best overall solution complete e-learning modules and complete a number of -Non-clinical peer assessments were rolled out in 2019 through random selection. based on the level of risk mitigation and cost mentoring sessions. ^When deficiencies are discovered, SCERPS are issued based on the risk of patient harm and number of infractions

Page 2 of 4 CASLPO Risk Register Excerpts for Council May 2019

Risk Rating Risk Tolerance

Likelihood: Zero 1=Rare; Impact: 2=Unlikely; 1=Insignificant; Low 3=Moderate; 2=Minor; Moderate Responsible 4=Likely; 3=Moderate; Risk Risk Group/ 5=Almost 4=Major; Current Treatment/ Sector Category Description of Risk Event/Situation/Outcome Department Certain 5=Catastrophic High Link to Strategic Objectives and Mitigation Additional Treatment Necessary 10 B. Core B.5 Changes in practice environments (i.e. private practise, BO/AC 4 4 Low -A full time Audiologists providing practice advice was added to staff in 2017 to address the trends we are seeing *In 2020, 4 indicators will be added to the Self Assessment tool Business Standard members working for hearing aid manufacturers, tele with respect to Audiology members to target areas of concern we're seeing in Professional Conduct Processes Setting practice ) creates "regulatory drift" -CASLPO hosts webinars targeting private practice AUD & SLP's - topics cover current practise issues and risks (Advertising, Conflict of Interest, Professionalism and Clinical specific to sole practitioners. These webinars were recorded and can be accessed on our website Reasoning). These indicators will also be targeted in peer ^More members are moving to private practise -Practice advice articles for Ex-press and Regional seminar outreach are based on issues arising in practice assessment. ^Tele practice remains an issue as there is no registration advice *Aligned with the strategic direction of risk based regulation for process to address this situation -All past articles related to practice advice are housed in a repository on the CASLPO website the 2018-2021 strategic plan, the Practice Matters Committee ^Difficulty engaging AUD's in the past but engagement is -In 2017, CASLPO will made a presentation on the Regulatory Requirements of Private Practitioners at the OSLA will be reviewing standards to ensure they reflect issues we're improving conference seeing from members in private practise and other ^AUDs are trying to create virtual online clinics in Canada -In 2017, there were E-forums addressing the use of support personnel and advertising environments where issues may exist (these virtual clinics already exist in the US) that do not -In 2018, there were E-forums focussing on billing and 3rd party payers, Conflict of Interest (COI), comply with current practice standards professionalism and communicating a diagnosis ^More complaints are being received against AUDs relating -Bill 160 was passed in 2018 and requires health professionals to disclose relationships with manufacturers. A to documentation and record keeping public register will be created with this information. -In 2019, a COI standard was introduced to address known risks and clarify the standard in a simplified approach

12 B. Core B.6 Complaints received regarding members are not resolved BO/PS 4 4 Low -CASLPO is in compliance with the legislation which dictates the minimum required processes to complete when a *Beginning in May 2019, CASLPO has hired a Case Manager for Business Self Regulatory in a timely and satisfactory manner resulting in threats to complaint is received. a nine month contract to manage a group of 118 complaints. Processes Role self regulatory status. -Documentation of key processes is provided to committee members and committee members receive *CASLPO is training an internal resource (Manager of continuous professional development Investigations and Hearings) to complete investigations. An in- Âs of May 2019, 161 active files remain open. 118 files -Upon receipt of complaint, an analysis is completed by staff to assess the level of risk to the public. Based on house investigator will allow CASLPO to better control and relate to a group of complaints received in 2019. Of the the assessed level of risk, the committee can immediately act by: potentially reduce timelines. The goal is to have an in-house remainder of files, 84% (36) have been open longer than 1. Ordering an interim suspension if the risk of public harm is high (i.e. sexual abuse allegations); investigator trained and available to take on high risk or time 150 days. 2. Appointing an investigator (i.e. protecting integrity of records in inappropriate billing allegations) sensitive investigations by 2020. ^The number of new complaints and reports has remained -Alternative Dispute Resolution (ADR) and mediation is offered for low risk complaints. This approach may consistent year over year; exceptions in 2015 (+ 14 improve the satisfaction of the outcome among the parties. complaints) and 2019 (+118 complaints) -ICRC committee reviews the case and assesses whether an investigation is necessary. The Director of Învestigations can be lengthy and unpredictable and it is Professional Conduct monitors the investigation to ensure adequacy. difficult to make external investigators accountable to us -Experienced investigators and experts are contracted for a timely outcome -ICRC meetings are held on a more frequent basis (every six weeks) to ensure that decisions and dispositions ^Lengthy investigations give members more time to are made in a timely manner circumvent processes and alter evidence therefore creating -Decisions can be appealed by the complainant or the member if is felt that the case was not dealt with in a more delays satisfactory manner ^The Registrar has the ability to grant an extension if -Processes are in place to ensure that members comply with orders resulting from ICRC and Discipline (i.e. reasonable reimbursements of legal costs, mentorship for member) -External delays are beyond our control -Professional conduct and practice advice departments collaborate to work through clinical issues that arise with -There are internal disruptions (i.e. staff turnover) complaints and provide professional conduct with technical expertise that could help guide an investigation that cannot be completely mitigated Încreased coverage of discipline outcomes in the media causing the public to question their trust in the current self- regulation model ^Government has commissioned inquiries and is considering recommendations from research studies that recommend radical changes to improve health regulation

Page 3 of 4 CASLPO Risk Register Excerpts for Council May 2019

Risk Rating Risk Tolerance

15 A. Legal/ A.3 Legal obligations with respect to Labour Mobility public BO/CB/CM 4 4 Low -Federal funding of over $1M was received in 2016 to complete all projects necessary for harmonization by *By Fall 2019, CAASPR will establish a plan to keep CAASPR Regulatory Other Laws & protections are not being fully addressed 2019. running and financially viable once the federal funding is used Regulations -Quarterly compliance reports must be submitted to the funding agency (ESDC) *Proposed harmonization require a change in our Registration ^CAASPR has been in the process of harmonizing -Consultants for all major projects have been engaged through a tendering process regulation. The proposed revised Registration regulation has standards / regulations / processes for over 5 years. The -CASLPO is part of the board and ensuring that projects are moving along been submitted to the Ministry for a 45 day posting. Once the goal is to have all harmonized processes in place by Fall -Governance structure has been established with the Board posting period is completed, CASLPO will submit the proposed 2020. -Currently, the majority of projects are on track. Project delays or obstacles have been identified and are being regulation to the Ministry. Typically, the process for Ministry ^CAASPR board has a history of dysfunction and it is addressed. approval is long and it is not know when approval will be proving difficult to get consensus among all provinces on a received. SAC, who is the exam provider for CAASPR, is aware number of projects of our circumstances and the possibility that our regulation will ^The Ministry could contend that provinces are not in not be passed by the Fall 2020 date for the first exam sitting. compliance with Labour Mobility legislation and Provincial *During 2019, CASLPO will plan the timelines for exam Internal Trade agreements implementation based on a number of variables and identify when students will need to be notified that an entry-to-practice exam is required for registration.

Page 4 of 4 APPENDIX B

Fraud Risk Assessment Checklist Excerpt for Council

Fraudulent Financial Reporting and Misappropriation of Assets are types of intentional behaviours (fraud) which may cause an organization's financial statements to be materially misstated.

Management's process for assessing the risks to the Organization includes evaluating incentives, pressures, and opportunities for fraud within the Organization as well as evaluating the Organization's existing operations risk register and internal control system for new exposures (risks). New risk exposures may result from changes in the risk profile of the Organization's operations, changes in pressures and incentives for individuals to perpetrate fraud, and/or from changes in the Organization's operating processes.

Step 1 - Document the current system of internal controls and identified risks of material misstatement to the financial statements Step 2 - Use this worksheet to identify circumstances and events which have changed since the date of the last assessment. Step 3 - Review the existing internal controls and identify means of overriding these controls (consider means, individuals involved, and mitigation)

What was the date of the last assessment? May 2018 What is the date of the current assessment? May 2019

Change New risk(s) identified? identified? Describe the new risk identified and what could go A. Fraudulent Financial Reporting Yes / No Yes / No wrong OR document the previously assessed risk Mitigation action(s) Ref. 8 Have any new deficiencies in internal control components been identified? Yes Yes New Risk -All vendor payments will be made by cheque. The only Payments made by interac e-transfer are not secure and exception is for payments to Visa which are completed can be intercepted. through online banking as a registered bill payment.

Consider deficiencies including: • Inadequate monitoring of controls, including automated controls and controls over interim financial reporting (where external reporting is required). • High turnover rates or employment of staff in accounting, information technology, or the internal audit function that are not effective. • Accounting and information systems that are not effective, including situations involving significant deficiencies in internal control.

MEMORANDUM

SUBJECT: REGISTRAR’S REPORT TO Council FROM Brian O’Riordan

DATE May 16, 2019 MEETING DATE June 6, 2019

INTRODUCTION

Since our last Council meeting on March 1, 2019, I have been focused primarily on college governance matters and CAASPR projects and meetings.

OPERATIONAL MATTERS

• Midyear evaluation of Annual Performance Goals for all staff completed. • Remediation work at CASLPO offices resulting from building emergency of November, 2018, completed; insurance payment to CASLPO being confirmed. • Certified Health and Safety Consultant hired for a 3-month contract to develop and implement a health and safety program that meets MOL workplace standards. • All staff have undergone 3 training sessions: o Communication – Influencing Skills o Project Management o Mandatory Health and Safety Training • 25th Anniversary Update (See Memo) • Temporary Case Manager, Grace Maharaj, engaged in May re large influx of complaints • Co-presented a CASLPO e-forum on Discipline Outcomes – March 21

COMMITTEE MEETINGS ATTENDED

• Patient Relations – April 29 • ICRC Panels – April 1 and May 7 & 21 • Executive– March 18 and May 24 • Finance – May 14 EXTERNAL MEETINGS/EVENTS • FHRCO Board - April 25 • OSLA/CASLPO Liaison Meeting – April 23 • CAASPR meetings: o Exam Implementation Working Group – April 1, April 29 and May 13 o Registrar’s Committee meetings – March 25 & 26, Winnipeg, April 18, May 23 o Board of Directors meeting – Shediac, NB, June 1-3 • Represented CASLPO, with Laura Bartolini, at the 25th Anniversary event for the College of Dental Hygienists of Ontario – March 20 • Attended Ontario Bar Association- Tom Marshall Award dinner – Richard Steinecke award recipient – also attended from CASLPO, Preeya Singh and Chevonne Cordle INTERNAL MEETINGS/EVENTS • Staff Directors meetings – March 8, May 2 (new format and content implemented) • Project Management training for all staff – March 11

CASLPO●OAOO

Centralization and Capacity-Building Project – Monthly Updates

Registrars’ Committee, Monthly Summary – April 2019 *Note this is an internal project document intended for CAASPR member regulators only.

The following constitutes a tabular summary regarding the status and next steps associated with active project elements. Those elements which have been competed or have not yet begun are not detailed below.

Items colored green indicated that a given project element is proceeding as planned in terms of timing and cost. Yellow indicates a moderate variation relative to initial plans that may require intervention to correct. Red indicates a major variation that requires immediate attention from CAASPR members to rectify and proceed.

The monthly report is predicated on the agreement by ESDC to allow for an extension of the project completion to March 31, 2020. The individual previously assigned by ESDC to monitor our project has changed. We are seeking written confirmation from ESDC on the extension.

The British Columbia registrar has advised the CETP sub-group that he will no longer be participating on that committee. It is important that CAASPR and British Columbia verify the ongoing degree of participation by BC in the Centralization and Capacity-Building Project.

Definition of Harmonization and Centralization

Status Update Next Steps

Back on CAASPR has achieved a major The new flow chart has been approved in Track! breakthrough in embracing a revised principle. This has unplugged our process vision respecting the degree in which to allow us to complete the project to the each jurisdiction will participate in satisfaction of all jurisdictions, and will harmonization and centralization. The achieve all project objectives and new protocol allows for ALL deliverables in a modified format. jurisdictions to continue to participate in the “centralization” project. Clarification must be received from British Columbia as to whether they will indeed participate, and to what degree.

Exam Development (Administration) Status Update Next Steps

On schedule A Master Service Agreement with Work continues on finalization of policies SAC has been signed – to develop and procedures. John Wickett (as our and deliver national entry-to-practice consultant) continues to work with SAC to examinations on behalf of CAASPR. wordsmith the policies and identify which Statement of Work has been ones “belong” to CAASPR and which ones completed. to SAC. The CETP sub-group will continue to review both the policies and draft FAQs.

CAASPR will retain specialized legal council to vet the final work (on those items identified as being in CAASPR’s purview), and in some cases write final policy wording to address any potential issues related to sub-delegation of authority.

Exam Development (Blueprint) Update Next Steps

On schedule Blueprint approved by the CAASPR French translation has been completed. board in October, 2018. Blueprint has been provided to SAC.

Memorandum of Understanding Status Update Next Steps

Unstuck,. Consideration of individual MOUs The project manager has been directed by the and to be completed by each registrars to retain legal counsel to facilitate the beginning to jurisdiction has been put on hold, “review” and potential redrafting of the template move. pending further discussion as to MOU’s for consideration by each jurisdiction. each province’s degree of The MOU will be executed with CAASPR as one party and the individual regulated jurisdiction as the other. Particular attention will need to be

participation in the project paid to those jurisdictions with Fairness ↗ deliverables. Commissioners.

Business Plan Status Update Next Steps

On schedule HRSG presented their report to the The board/registrars will consider how to board in October of 2018 and has operationalize the matters raised in the been accepted by the board. business plan. Informational meetings have taken place with OTs and Physiotherapists to

assist the registrars on issues related to long term sustainability.

Website Portal Status Update Next Steps

On track Digital Echidna has been secured Work has begun with Digital Echidna and a to complete the web portal CAASPR sub-group to allow them to complete

project. Contract has been their work to create the web portal which signed. . satisfies the desires of all jurisdictions and the exam vendor.

Academic Equivalency Framework Status Update Next Steps

On schedule Jennifer Cupit has been retained to Jennifer Cupit provided her in person update complete this project, which to the registrars at the March meetings. Work includes the development of will continue with a slightly revised time

centralized assessment processes schedule. An update will be presented to the and assessor manual. board in June.

Mentorship Program Research Status Update Next Steps

On schedule James and Associates have been Based on the amended instructions retained to complete this project. The provided to the consultant, she will Executive has met with the consultant proceed to draft an interim report. and have reached an agreement on more focused objectives and deliverables. The project will no longer include a survey component.

Common application form and licensure information hosted on CAASPR website; Status Update Next Steps

Appropriate There are two separate topics here. 1) The creation of an application form to Time the creation of an application for establish a profile on the website will meet Remaining in establishment of a profile on the web the goals and objectives of the ESDC the project portal; 2) whether there is a desire to project. to complete create some form of general application this for licensing registration in all jurisdictions.

Ms. Josée Levasseur Chair Canadian Alliance of Audiology and Speech-Language Pathology Regulators (CAASPR)

May 14, 2019

Dear Ms. Levasseur,

As President of the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) I am respectfully writing to you on behalf of the Council of the College in order to present you with our thoughts and recommendations concerning the present state of CAASPR projects and organizational issues.

INTRODUCTION

The Executive and Council of the College have had several recent lengthy discussions about the national projects being worked on by CAASPR under the aegis of funding from Employment and Social Development Canada (ESDC). We also focused on matters concerning the ongoing sustainability of CAASPR as a viable alliance of professional regulators.

In March 2019, our Executive Committee, as mandated by our Council, had a full-day meeting solely devoted to reviewing CAASPR matters, with a view to communicating our concerns about the present situation.

We want to first acknowledge the many achievements of CAASPR over recent years, including: agreement to implement national entry-to-practice examinations for both professions; the establishment of national professional competencies for both professions; agreement to utilize an Academic Equivalency Framework for applicant assessments; and the adoption of a national Language Proficiency Standard. All this has been achieved by a working board without the aid of any full-time dedicated staff.

BACKGROUND

CASLPO was one of the founding members of CAASPR back in 2008. Our Registrars, first David Hodgson and then Brian O’Riordan, have previously chaired the CAASPR board. As well, many of our staff, including Deputy Registrar Carol Bock, Colleen Myrie, Alex Carling, Jennifer Cupit, Samidha Joglekar and Emily Hogeveen have contributed countless hours in the service of CAASPR projects and committees. Seven different presidents of CASLPO have served as members of the CAASPR board. Currently, Mr. O’Riordan also serves as co-Chair of the joint CAASPR/SAC National Exam Implementation Advisory Group, and served for three years on the CAASPR Executive Committee, 2015 – 2018.

1 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

In 2010-2011, CASLPO provided $125,000 to CAASPR for the organization to engage an Executive Director, Karen Luker. We have been pleased to host many CAASPR meetings over the years at the College offices. We have absorbed overhead office costs to support the work of Jennifer Cupit as a consultant to CAASPR, Anthony Thomas as a bookkeeper and Emily Hogeveen as a corporate administrative assistant and assistant to the national Project Manager.

CASLPO, through its organizational membership fee, contributes currently over $20,000 annually to CAASPR’s budget, representing a quarter of CAASPR’s total annual revenues. The College presently has over 4,200 registrants, representing a third of all SLPs and AUDs in Canada. The College manages an annual budget of over $3M. There are eighteen members on our Council, including seven public members. We have a staff complement of fourteen, and are members of the Federation of Health Regulatory Colleges of Ontario (FHRCO).

We view our participation in CAASPR as central to our role as a regulatory College. We have willingly embraced taking on additional costs and responsibilities because the work of CAASPR and the issues and matters it deals with are of crucial and integral importance in assisting us to fulfill our mandate of working in the public interest. Before providing you with our views and analysis, we felt it was important to first provide you with an historical perspective on our involvement, commitment, dedication and cooperation.

With the advent in 2009 of mandatory compliance with the Agreement on Internal Trade (AIT), professionals working in one regulated province can move to another province and obtain a permit/certificate/license of registration in another province in a virtually barrier-free manner (“permit- to-permit” registration). This means that all decisions to license individuals in a given province have national implications for patients being treated by labour mobility member transfers. Each provincial regulator is essentially making decisions on behalf of all other regulatory provinces, and those decisions can potentially affect the health care of Canadians in every province and territory. For further information on labour mobility issues, please see our legal opinion of March 15, 2019 which was sent previously, and is attached hereto.

CAASPR, similar to dozens of other regulatory health care professional alliances immediately grasped in 2009 the implications of this situation in terms of patient safety and risk, and the need to harmonize occupational standards, including required competencies.

At the end of the first period of CAASPR-allocated ESDC project funding (2011-14), CAASPR had developed a draft set of national professional competencies and a language proficiency standard. There was also agreement to establish national entry-to-practice exams and to centralize assessment processes with respect to internationally-educated applicants.

In the second ESDC-funded project period, 2016-2019, CAASPR has made substantial progress in many areas, but faces policy and implementation challenges with respect to the assessment of internationally- educated applicants; exam application procedures; and exam regulatory approvals (Alberta and Ontario).

We can assure you that we are doing everything in our power with our provincial ministry to expedite approval of our new Registration regulation so that it will be in place for the projected first sittings of the National Exam in the fall of 2020.

2 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

We, of course, hope that our counterparts in Alberta will also be successful in having their provincial government approve their regulatory change in time for the first national exam sittings, and we urge CAASPR to assist Alberta in whatever way it can in this endeavour. CASLPO would also like to offer its assistance to ACSLPA.

We will now set out several areas of concern with respect to the work of CAASPR.

ISSUE 1 Assessment of Applicants:

Our first area of major concern relates to the assessment of those who wish to write the national exam. We understand that recently the colleges in Alberta and British Columbia, have raised concerns about this aspect of exam readiness.

In British Columbia’s case, the concern appears to centre on whether CAASPR’s contemplated procedures for generating a list of exam-ready candidates infringes on a regulator’s authority to make the ultimate decision on the registration of an applicant who successfully passes the exam. As set out in CASLPO’s letter to Cameron Cowper of March 15, 2019 (see attached), we do not think that this is the case.

It is our understanding that many health care professional colleges in BC are members of national alliances which support the successful passing of national exams as a criterion for registration and attendant centralized processes for exam candidate application. We understand that BC is having its legal counsel review our March 15, 2019 letter, and will be responding to our letter at the CAASPR Board meeting in June.

In the case of Alberta, we have noted that the letter from ACSLPA to the CAASPR Board of January 30, 2019, confirms our understanding that the Health Professions Act in Alberta allows colleges to delegate duties, powers and processes to an organization such as CAASPR. Therefore, there does not appear to be any legislative hurdle in the way of agreeing to the exam applications processes set out in CAASPR’s Service Agreement with SAC. Rather ACSLPA’s opposition appears to rest on its belief that CAASPR does not have the capability to administer the application processes and the national assessment procedures involving internationally-educated applicants.

We understand that currently CAASPR is making efforts to accommodate the positions of Alberta and British Columbia through a Working Group which is developing an Application Flow Chart and through ongoing discussions within the Registrars Committee. While this is laudable, we would also urge CAASPR to engage in substantive discussions with representatives of both Colleges in order to address their concerns. Having three or four different assessment processes for exam readiness could be confusing for applicants. If the colleges in Alberta and BC continue to have concerns, and if CAASPR is unable to find a way to accommodate the two provinces, we believe those colleges, in the interest of transparency and openness, could be asked to share with other members of CAASPR their processes and criteria for assessment of internationally-educated applicants and applicants from non-accredited Canadian university programs. In this way, all CAASPR members will gain a better understanding of the assessment processes being used in those two provinces leading to greater confidence/comfort with receiving labour mobility applicants from those provinces.

3 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

Issue 2: Organizational Sustainability

Introduction:

The other cluster of major issues which concern us regarding CAASPR, are related to the organization’s short-term and long-term sustainability. CAASPR has received several recent very good reports which could guide its deliberations in terms of strategic planning. We are thinking in particular of “Review of Assessment Models for Internationally-Educated Applicants” by Kathy Davidson Consulting (September 2017) and “CAASPR Business Plan”, prepared by the Human Resources Systems Group (October 2018). While both reports were received by the CAASPR Board, there does not appear to be any sustained effort to use either report as a basis for creating long-term organizational strategic plans. CAASPR invested very significant amounts of ESDC funding to support the two projects. Both reports contain excellent models for organizational and financial sustainability, but to date it is our understanding that CAASPR has been reluctant to utilize either report as a guide to the future. Some of this reluctance appears to be connected to the lack of agreement on the importance and benefits of harmonization. Other reasons seem to relate to the ongoing interpersonal levels of discord and lack of engagement within the Registrars Committee.

CAASPR needs to find a way to re-focus on plans for short-term and long-term sustainability and set out clear timeframes and milestones for the achievement of its objectives. Barriers to achieving this should be worked on immediately by the leadership of CAASPR, with a view to eliminating any obstacles toward regaining levels of interpersonal collegiality and trust.

Corporate Sustainability Issues:

It appears that there is consensus among CAASPR members that the current “working board” model (dating back to 2015) is not sustainable. CAASPR, as a national alliance of regulators, needs to be resourced adequately if it is to be of value to its members, stakeholders and the public.

We would, therefore, propose that CAASPR undertake the following immediate steps:

1. Increase membership fees from $5/registrant to $10/registrant 2. Hire an Executive Director along with part-time administrative and bookkeeping expertise 3. Engage corporate legal counsel (CAASPR has been without legal counsel for over a year) 4. Engage a website designer to overhaul the organization’s website to give it a more professional look and be user-friendly and efficient.

We note that many national alliances of regulators have more staff, office space and higher fees and budgets than CAASPR. We feel CAASPR, especially with advent of the implementation of the national exam and the end of ESDC project funding in the fall of this year, needs to assign a high priority to corporate reform on many levels.

A lack of dedicated staffing resources has also impacted CAASPR’s relations with major stakeholders, particularly Speech and Audiology Canada (SAC) and the Canadian Council of University Programs in Communication Sciences and Disorders (CCUP-CSD). CAASPR also needs to build a more robust and ongoing relationship with national alliances of regulators, particularly those in the rehabilitation field.

4 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

Corporate Governance Issues:

We understand that the Governance Committee of CAASPR is working on a wide range of initiatives. We are hopeful that the large investment of time and money invested by CAASPR in governance initiatives will be fruitful.

CASLPO urges strong focus on making reforms in the following areas:

• Increase regularity of board meetings to four per year and keep costs down by potentially reducing the size of the current board from sixteen to a more manageable size of eight, which is consistent with other national alliances of regulators • Establish a fit-for-purpose governance structure by revamping the current corporate By-law • Establish governance training sessions for board members and orientation sessions for new board members • Establish protocols for confidentiality of CAASPR documents • Establish attendance requirements for board and committee meetings • Develop a set of “rules of order” for both board and committee meetings • Develop an organizational “Strategic Plan” • Require the Registrars to engage in a facilitated session to address issues of interpersonal dynamics and communication • Upgrade stakeholder management communications, particularly with respect to SAC and CCUP and national alliances of other health care professionals.

CONCLUSION

We hope that the board of CAASPR will receive this communication in the spirit in which it is advanced. It is submitted with the greatest respect and in the sincere hope that it will contribute to promoting discussions on an urgent basis on the issues and items which we have raised.

Thank you for your consideration. We look forward to your written response.

Please forward this letter to all board members of CAASPR as soon as possible, as we hope it can be included on the agenda of your upcoming board meeting in Shediac, New Brunswick.

On behalf of CASLPO Council,

Yours sincerely,

Bob Kroll President, CASLPO

5 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

Members of CASLPO Council:

Jennifer Anderson, (AUD) (Executive) Tina D’Agnillo, (SLP) (Executive) Véronique Vaillancourt, (AUD) (Executive) Melanie Moussa-Elaraby (Public) (Executive) Ruth Ann Penny (Public) (Executive)

Lynn Ellwood, (SLP) (Academic, University of Toronto) Elizabeth Fitzpatrick, (AUD) (Academic, University of Ottawa) Tara Barber, (SLP) Karen Bright, (SLP) Kim Eskritt, (AUD) Pam Millett, (AUD) Yvonne Wyndham, (SLP) Robert Metras, (Public) Donna Mooney, (Public) Satpaul Singh Johal, (Public) Shari Wilson, (Public)

6 | P a g e 3080 Yonge Street, Suite 5060, Toronto, Ontario M4N 3N1 www.caslpo.com Phone: 416-975-5347 • Toll Free: 1-800-993-9459 (ON only) • Fax: 416-975-8394 [email protected]

2018-2019 HIGHLIGHTS

FEDERATION OF HEALTH REGULATORY COLLEGES OF ONTARIO

ABOUT THE FEDERATION

CONTENTS: The Federation of Health Regulatory Colleges of Ontario is an incorporated, not- for-profit organization comprised of Colleges of the 26 regulated health President’s Report 2-3 professions in the province. The Federation focuses on regulatory matters as it promotes effective communication and cooperation among its members. Committee Reports 2, Activities that support the fulfilling of the Federation’s purpose include the 4-6 following: Educational 4 • Collective work on government priorities Opportunities • The sharing of promising practices and the identification of new initiatives FHRCO Member 4 • Communication about the role of the regulator to the public and stakeholders Staff Key Area Networks • Ongoing support for existing Colleges • Mentoring for new regulators Transitions 7 • Development of tools and materials to support the healthcare system in Online Resources 7 regulatory areas • Stakeholder collaboration and project participation FHRCO Members 8 • Delivery of education to support key College function areas

FOCUSING ON GOVERNANCE

Kevin McCarthy, the College of Nurses of Ontario’s Director, Strategy, presenting at FHRCO’s Governance Workshop on December 3, 2018. Read more about the session on page 3. 2018-2019 HIGHLIGHTS

Executive Committee PRESIDENT & EXECUTIVE COMMITTEE REPORT Members: This report covers the Federation’s corporate year from the May 4, 2018, Kevin Taylor, President Annual Meeting to the April 25, 2019, Annual Meeting. (effective October 10, 2018; previous Vice- FOCUSING ON PRIORITIES AND PLANNING President) In December 2018, the Federation’s Board of Directors participated in a facilitated discussion related to the organization’s purpose and priorities, Shenda Tanchak, recognizing the changing regulatory landscape and promising practices in President (until organizational governance. September 25, 2018)

Elinor Larney, Vice- A confirmation of issues opened the day followed by an identification of President (effective FHRCO’s critical functions that would address those issues. Prioritization was October 10, 2018) the next step, along with an agreement to keep the conversation going. Outcomes from those discussions are anticipated to come to fruition in the Judy Rigby, Treasurer 2019-2020 year. Jo-Ann Willson, Member

Linda Gough, Past President

(Back row, from left): Brian O’Riordan (CASLPO), Anne Coghlan (CNO), Lisa Taylor (CDHO), Fazal Khan (College of Opticians of Ontario), Andrew Parr (CONO), Basil Ziv (CHO), Rod Hamilton (College of Physiotherapists of Ontario), Glenn Pettifer (College of Denturists of Ontario), Corinne Flitton (CMTO), Kelly Dobbin (CMO), Melisse Willems (College of Dietitians of Ontario), Allan Mak (CTCMPAO) (Front row, from left): Jo-Ann Willson (CCO), Brenda Kritzer (COKO), Linda Gough (CMRTO), Kevin Taylor (CRTO), Elinor Larney (COTO), Maureen Boon for Nancy Whitmore (CPSO), Paula Garshowitz (College of Optometrists of Ontario) (Regrets): Irwin Fefergrad (RCDSO), Nancy Lum-Wilson (OCP), Rick Morris (College of Psychologists of Ontario), Judy Rigby (CDTO), Felicia Smith (COCOO), Kathy Wilkie (CMLTO)

Page 2 2018-2019 Highlights

PRESIDENT & EXECUTIV E COMMITTEE REPORT ( CONT.)

OFFICE OF THE FAIRNESS COMMISSIONER OF ONTARIO (OFC) FHRCO: Elinor Larney continues to serve as FHRCO’s member on the OFC’s Stakeholder Engagement Committee, serving as a conduit for information-sharing. The Fostering Federation met with the Fairness Commissioner to hear more about the Office and its work related to Colleges’ French-language requirements in their registration Healthy processes. Regulatory COLLEGE GOVERNANCE A priority for the Federation continues to be helping Colleges stay informed and be prepared for changes in the area of College governance. A FHRCO Governance Collaboration Session was provided on December 3, 2018, featuring Anne Coghlan, Executive Director and CEO of CNO, with Kevin McCarthy, Director, Strategy, who presented in information on CNO’s “Governance Vision 2020”. Richard Steinecke, Steinecke Maciura LeBlanc and FHRCO legal counsel, then provided some “Perspectives on Ontario Governance”. There were 70 in attendance; 20 Colleges were represented.

FHRCO INTERVENES IN IMPORTANT CASES The Federation continues to take action when cases arise that relate to significant matters relevant to its members and to the Federation’s purpose, and it would be in the public interest to intervene. FHRCO had received intervenor status in the case Abdul v Ontario College of Pharmacists. The case was heard on May 8, 2018, with an outcome positive for health profession regulation in Ontario.

MEETINGS WITH KEY STAKEHOLDERS AND THE FEDERATION BOARD OF DIRECTORS/EXECUTIVE COMMITTEE DURING 2018-2019 YEAR: • Deanna Williams following her work on recommendations for the Ministry of Health and Long-Term Care (MOHLTC) related to patient sexual abuse • MOHLTC Health Workforce Planning and Regulatory Affairs Division, providing general updates: • Denise Cole, Assistant Deputy Minister (ADM), with Lorraine de Braganca, A/Executive Assistant to the ADM • Health Workforce Regulatory Oversight Branch: • Allison Henry, Director • Stephen Cheng, Manager, Strategic Regulatory Policy Unit • Thomas Custers, Manager, Regulatory Oversight and Performance Unit, focusing on the College Performance Measurement Framework Project • Marsha Pinto, Manager, Regulatory Design and Implementation Unit • Doug Ross, Sr. Policy Analyst, Regulatory Oversight and Performance Unit • Ontario’s Fairness Commissioner Grant Jameson with Kim Bergeron, Senior Program Advisor (see above) • Office of the Patient Ombudsman: Craig Thompson, Executive Director, to learn more about the Office and how Colleges and the Patient Ombudsman relate in Ontario’s healthcare system Page 3 2018-2019 HIGHLIGHTS

INVESTIGATIONS AND H EARINGS NETWORK

Co-Chairs (2018) The Investigations and Hearings Network, open to all Federation members • Shaf Rahman (CRTO) staff involved in investigations and hearings, provides Federation member • Bonita Thornton staff with opportunities for regular meetings and online resources to share information and practice questions. (College of Physiotherapists of A Symposium was held on June 22nd that focused on the Health Professions Ontario) Appeal and Review Board (HPARB), with presentations by Christy Hackney, Registrar & Senior Manager of the Health Boards Secretariat, and Taivi Lobu, Co-Chairs (2019) Vice Chair, HPARB, along with Alexandra Wilbee of WeirFoulds, and Nicole • Andrea Lowes Zweirs (CPSO) and Wendy Waterhouse (RCDSO).

(CDHO) A second Symposium was held on November 27th , featuring Bonni Ellis who • Amy Stein (College of presented on expert witnesses. The event was hosted by OCP and had 30 Opticians of Ontario) attendees from 15 Colleges.

EDUCATIONAL OPPORTUNITIES

Federation members’ Councils, Committees, and staff are provided with resources for their individual orientation, ongoing education, and training needs: • Governance Workshop (first held in 2018) • Education for Health Professional Regulators of Ontario (EHPRO) (all aspects of the RHPA available online for members) • Training Videos about Patient Sexual Abuse (available online for members) • Discipline Orientation Workshops (see p.6 for more information) • Investigations and Hearings Symposia (see above for more information) • Communications Conferences (see p.5 for more information)

FHRCO MEMBER STAFF KEY AREA NETWORKS Staff have access to Networks for key College areas of activity, including the following: • Communications • Practice Advisors • Corporate Services • Quality Assurance • Investigations and Hearings • Records Management • Policy • Registration

Page 4 2018-2019 Highlights

COMMUNICATIONS COMMI T TE E

FHRCO’s Communications Committee, led by Monique Poirier, Communications Committee continues to provide for opportunities to share expertise, focusing on Members: support for the output of the Public Engagement Program - www.ontariohealthregulators.on.ca • Monique Poirier (College of (OHR), the public-facing website that Dietitians of Ontario), Chair provides links to Colleges, specifically • Angie Brennand (CMTO) their public registers, information • Lisa Gibson (CASLPO) about complaints, and public • Margaret Goulding (CMLTO) consultations. This initiative is • Kristi Green (CNO) consistent with Colleges’ duty to • Sabina Hikel for Shauna Grey promote and enhance relations (CRPO) between Colleges and the public. • Victoria Marshall (CMO) through February 14, 2019 Public outreach through “OHR” was a focus for the Committee with meeting the power of Google ads and boosted Facebook postings harnessed to • Lisa Pretty (College of promote the site over the past year. Additionally, all members of Physiotherapists of Ontario) provincial parliament received • Mark Sampson (CPSO) letters, letting them know about • Nancy Stevenson (COTO) OHR so that they could share information with their constituents. Directly interacting Communicators’ Day with the public, many Planning Subcommittee Communications Committee Members: members and Practice Advisors • Mark Sampson (CPSO), from their College teams also Chair staffed a booth at the Zoomer • Angelo Avecillas (RCDSO) Show on October 27 & 28, 2019. • Maria Feldman (CMTO) The success of that event led to • Tova Wallace (College of confirmation of show Physiotherapists of attendance in 2019 - October 24 Ontario) & 25. (See CASLPO’s Facebook post from the event, right.)

Another key event for the Communications Committee was the Communications Network-wide annual Communicators’ Day, held on November 23rd and hosted by CPSO. The Day included presentations from the College of Social Workers and Social Service Workers, and The Change Foundation. This opportunity for College communications staff to interact and learn from others’ experiences was well-received, with 35 attending from 23 Colleges. Thanks to Conference Planning Subcommittee chair Mark Sampson (CPSO) for leading this event. Page 5 2018-2019 HIGHLIGHTS

DISCIPLINE ORIENTATI ON COMMITTEE

Discipline Orientation The Discipline Orientation Committee continues to deliver quality education and Committee Members: training programs, providing comprehensive orientation for regulatory adjudicators. Basic training programs are available twice each year. Advanced • Tina Langlois sessions are held annually and are built on the knowledge and skills regulatory (CMRTO), Chair adjudicators acquired by attending the Basic session or participating in hearings. • Eyal Birenberg

(College of 2018 Workshops: Optometrists of Ontario) May 25 – Basic Program: 34 registrants (13 Colleges represented)

• Aoife Coghlan (COTO) November 1 & 2 – Basic and Advanced Programs: 22 Basic (13 Colleges) and • Genevieve Plummer 40 Advanced (13 Colleges) (OCP) • Ravi Prathivathi Future Discipline Orientation Program Dates for 2019: (CNO) Basic Sessions: May 3 & October 26 Advanced Session: October 27

NOMINATIONS COMMITTE E

The Nominations Committee facilitated the annual call for nominations List of Committee Members: for the Executive Committee and Officers positions as well as members of FHRCO Committees and Chairs. Elections and appointments take place • Linda Gough (CMRTO), Chair during the Board Meeting that immediately follows the Annual Meeting • Kathy Wilkie (CMLTO) each year. The dedication of the many volunteers and support from • Jo-Ann Willson (CCO) member Colleges is one of the greatest of FHRCO’s resources.

CONSENT AND CAPACITY WORKING GROUP

List of Working Group Members: The Consent and Capacity Working Group was created to develop collaborative educational • Melisse Willems and Deborah Cohen (College of materials to ensure healthcare professionals Dietitians of Ontario) (Chair) fully understand their legal and professional • Heather Binkle and Sandra Carter (COTO) obligations for obtaining consent in their • Alexandrea Carling, Samidha Joglekar, and Sarah practice settings. A survey of College members Chapman Jay (CASLPO) was conducted to help determine next steps. • Barry Gang (College of Psychologists of Ontario) Work continues by subgroups who are • Téjia Bain (College of Physiotherapists of Ontario) developing information to be shared with • Andrea Lowes (CDHO) College members regarding two identified • Lene Marttinen (CRPO) issues: capacity to consent and barriers to • Justin Rafton and Mina Kavanagh (College of obtaining consent. Optometrists of Ontario)

Page 6 2018-2019 Highlights

TRANSITIONS

FEDERATION MEMBERS: • Dr. Nancy Whitmore assumed the role of Registrar/CEO of CPSO on June 4, 2018. Dan Faulkner had served as Interim Registrar following the retirement of Dr. Rocco Gerace on February 28, 2018. • Rod Hamilton was named Registrar of the College of Physiotherapists of Ontario, effective December 18, 2018. Rod had served as Interim Registrar as of September 25, 2018, replacing Shenda Tanchak, Registrar & CEO. • Stamatis Kefalianos was appointed Acting Registrar of the CTCMPAO on April 9, 2019, replacing Registrar & CEO Allan Mak. • Dr. Paula Garshowitz announced her retirement as the College of Optometrists of Ontario’s Registrar, effective the end of April 2019; Paula will be supporting the transition for the new Registrar into the summer 2019.

EXTERNAL STAKEHOLDERS: • Hon. Christine Elliott was appointed Minister of Health and Long-Term Care on June 29, 2018. Dr. Helena Jaczek had served as Minister until the provincial election on June 7, 2018. • Helen Angus was appointed Deputy Minister of Health and Long-Term care on June 29, 2018, • Patrick Dicerni was appointed Assistant Deputy Minister of Health and Long- Term Care, announced on October 18, 2018, replacing Denise Cole who was assigned to lead an “expedited review of legislation and regulation to identify impediments to more effective and efficient operations of the health system and the Ministry in its oversight role.” • Grant Jameson, Fairness Commissioner, completed his term in that role on April 4, 2019.

FHRCO ONLINE RESOURC ES

• An Interprofessional Guide on the Use of Orders, Directives and Delegation for Regulated Health Professionals in Ontario • Interprofessional Collaboration (IPC) eTool • Positions Available at FHRCO Member Colleges • Information on College Council Meeting Dates

www.regulatedhealthprofefssions.on.ca Page 7 2018-2019 HIGHLIGHTS

Federation of Health Regulatory Colleges of Ontario

Members: College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) College of Chiropodists of Ontario (COCOO) College of Chiropractors of Ontario (CCO) College of Dental Hygienists of Ontario (CDHO) College of Dental Technologists of Ontario (CDTO) College of Denturists of Ontario College of Dietitians of Ontario (CDO) College of Homeopaths of Ontario (CHO) College of Kinesiologists of Ontario (COKO) College of Massage Therapists of Ontario (CMTO) College of Medical Laboratory Technologists of Ontario (CMLTO) College of Medical Radiation Technologists of Ontario (CMRTO) College of Midwives of Ontario (CMO) College of Naturopaths of Ontario (CONO) College of Nurses of Ontario (CNO) College of Occupational Therapists of Ontario (COTO) College of Opticians of Ontario College of Optometrists of Ontario College of Physicians and Surgeons of Ontario (CPSO) College of Physiotherapists of Ontario College of Psychologists of Ontario College of Registered Psychotherapists Therapists of Ontario (CRPO) Federation of Health Regulatory Colleges of College of Respiratory Therapists of Ontario (CRTO) Ontario (FHRCO) College of Traditional Chinese Medicine Practitioners and Acupuncturists of Ontario (CTCMPAO) Suite 301 - 396 Osborne St Ontario College of Pharmacists (OCP) PO Box 244 Royal College of Dental Surgeons of Ontario (RCDSO) Beaverton ON L0K 1A0 Phone: 416-493-4076 Fax: 1-866-814-6456 www.regulatedhealthprofessions.on.ca Email: [email protected] The Cayton Report

IS THE UK MODEL NOW INEVITABLE?

RICHARD STEINECKE

APRIL 25, 2019 2 Context

 CDSBC scandals  Handling of sexual comments by Registrar  Brain damage to sedated girl by dentist who broke all the rules resulting in a 3 month suspension  Takeover by the BCDA  News articles of chiropractors (including Council members) and naturopaths exceeding scope  PSA had done reviews of other BC regulators Short Term Reforms

 CNO model of Council composition (6 + 6 app’ted)  Merging of smaller regulators  Simplified complaints system  Triage, investigation, adjudication  Expanded duty to report publicly  Including complaints outcomes and data breaches  Review Board can self-initiate review of complaints decisions Longer Term Reforms

 Single set of ethical rules and conduct expectations for all professions  Adjudications by a separate body  Who would also manage a single public register for province  PSA-type independent oversight body  Would also conduct occupational risk assessment process Governance

 Board role:  Ensure compliance with mandate / law  Set strategy and monitor performance  Hold Registrar / CEO accountable for performance  Boards operate by consensus, not rules of procedure  No secret ballot votes  And few closed meetings  Board partners with staff  Dysfunction results from lack of respect and trust Other Governance Recommendations

 Candidates for Board → “induction programme”  Three year cooling off period from professional associations  Abolish governance committee  Board members do not procure directly  Board should not see itself as the College Regulatory Performance Failures

 Standards of practice not clear or communicated  Complaints process does not focus on harm  Corporate risk management lacking  Board oversight does not use KPI  Strategic planning not based on regulatory impact on patients and the public  Board members do not understand role External Relationships

 Almost all groups lack understanding of the public interest mandate of College  Relationship too close with professional association  FHRCO BC equivalent was a model of collaboration  Relationship approach to government was fine  But public appointments criteria and efficiency had gaps Protecting the Public

 Absolutely no advocacy role for regulators  Interests of the profession > of the public  Mandate “to serve and protect the public” too broad  Detracted from focus on safety  E.g., no patient relations program but spousal exemption  E.g., 3 month suspension in sedation case of girl who suffered permanent brain damage Comments I’m Not Ready to Accept, Yet

 A registrant who has an outstanding complaint against them should be ineligible to serve on Council  And should take a leave of absence if already on Council  Staff (and legal counsel) should not provide recommendations to the complaints screening committee Comments I’m Not Ready to Accept, Yet

 Setting aside time at Board meetings to hear comments and answer questions from members of the public  Wellness programs are the role of the professional association and regulators should not organize or pay for them 13

The Cayton Report: o ensuring the College complies with its mandate and the law The Wolf Finally Arrives o setting strategy and monitoring performance and by Rebecca Durcan o holding the registrar and chief May 2019 - No. 236 executive to account for delivery.  Boards should dispense with formal rules of For years observers have been saying that regulators procedure (e.g., motions and votes) and, with of professions are under intense scrutiny and unless rare exceptions, operate through consensus. they regained public confidence then self-regulation  Secret ballots have no place in a public body. without systematic oversight would end in Canada.  Secret meetings (in the absence of staff) Over time it has become easier to ignore these pleas should be extremely rare and require centrally as self-regulation continued to muddle along, but no maintained minutes. longer. While the analogy to the little boy who cried  The Board should partner with staff to achieve wolf is imperfect (no one would call the author of the the organization’s mandate; staff do not just report or his agency’s ideas “wolves”), the concept of administratively implement Board directions. snubbing previous warnings and subsequently facing  Dysfunction in an organization occurs when real consequences is relevant. Board members and staff no longer respect and trust each other. On April 11, 2019, the long awaited report of the Professional Standards Authority (PSA) (headed at The report’s recommendations include: the time it was written by Harry Cayton) on the Inquiry into the College of Dental Surgeons of British  Candidates for selection to the Board from Columbia was released. On the same day the Minister within the profession should be required to of Health gave the College thirty days to deliver an participate in an “induction programme” implementation plan for the recommendations before being chosen. directed at it. The Minister also announced that he has  Officers or representatives from the set up a steering committee to examine the professional association or similar bodies recommendations related to the oversight of all should have a three-year cooling off period regulated health professions. before they can serve with the regulator.

 The governance committee should be Governance abolished and Board officers should not attend

audit committee meetings unless invited. Some of the key observations in the report about governance include the following:  Board members should not procure goods or services directly. Procurement should be

through staff pursuant to appropriate policies.  Boards should focus on three things:  “The Board must stop seeing itself as the College and recognise that its role is to govern

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the College and oversee its performance but  The regulator does not collect and use that the College is run and managed by its performance and outcomes information about professional staff.” patients and the public as a part of its strategic planning. Measuring Regulatory Performance  The Board does not work cooperatively, with an appropriate understanding of its role as a The report assessed the performance of the College governing body and members’ individual according to the criteria that the PSA uses for the responsibilities. bodies it oversees. The following areas were found to have not met the standard: External Relationships

 Standards of practice do not identify The report identified a broad lack of understanding of mandatory expectations upon practitioners and the role of the College to regulate the profession in are unclear in some areas. the public interest. This was demonstrated by the  There is not a systematic and accountable election campaign statements, the perceptions of process for identifying and developing new or Board members from the profession and in the history revised standards. of various regulatory initiatives. Examples of the  Standards are not clearly worded nor are they regulatory initiatives of concern was the failure to effectively communicated to the profession implement a standard preventing dentists from and to the public. treating their spouses and the challenges faced by  Complaints are not appropriately assessed for attempts to implement an enhanced quality assurance risk and prioritized upon receipt. program. The report states:  The complaints process is not transparent, fair, proportionate and focused on public protection The College needs to build a different because of its composition, and because of the relationship with its dentist registrants: one of excessive role of staff and because of the both mutual respect and distance. It cannot do misuse of undertakings option. so when its Board is elected by registrants and  Complaints are not dealt with promptly with a partially subject to their control. It is hard for view to preventing harm to the public while in it to build a new relationship with the process. profession when it is so closely tied  Insufficient reasons are provided for actions financially and through personal contact and taken on complaints. individuals to the [professional association]  The regulator does not have an effective and other dental organisations. An process for identifying, assessing, escalating independent, effective, efficient, fair and and managing organizational risks. public focussed regulator is good for the dental community as a whole. It is especially  Board oversight does not include the effective use of key performance indicators and a good for skilled and ethical dentists who never corporate risk register. have a complaint.

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The report stated plainly that the relationship between I don’t think these perspectives are typical but the regulator and the professional association was too for dentists who are active in the College and close and strongly recommended the severing of dental community to express them suggests a many of those ties (e.g., the regulator cease collecting profound misunderstanding of the purpose of annual fees for membership in the professional professional regulation and lack of concern for association). the safety and well-being of patients.

The report commended the affiliation of the regulator The report noted that the mandate of the regulator “to with the other health regulators in a loose umbrella serve and protect the public” was broad. The report organization as a model of collaboration. expressed concerned that the regulator was reading the mandate it too broadly. The report suggests that The report indicated that while the regulator had the mandate of regulators “does not ask regulators to regular contact with the government, one aspect of the be responsible for public health or for access to health relationship that was not working well was the professionals”. appointment of public members to the Board. The criteria used in making such appointments were The report recommends that the mandate of regulators uncertain and there were too many vacancies. be narrowed to read:

In terms of engaging the public, the report noted a To protect the safety of patients, to prevent reluctance of the Board to engage with the public and harm and promote the health and well-being the lack of a strategy to more effectively obtain the of the public. input and perspective of the very people it is mandated to protect. The report illustrates these concerns. One instance was the failure of the regulator to establish, as Protecting the Public required by the legislation, a patient relations committee and a program dealing with sexual abuse. This portion of the report is perhaps the most hard- The only sexual abuse guideline developed by the hitting. It definitively states that regulators have no regulation was permissive rather than restrictive in advocacy role. It also says: nature (i.e., enabling dentists to treat their spouses).

A concern for the well-being of dentists rather Another example provided was the failure to than a single-minded focus on patient safety effectively enforce the standard related to sedation and public protection is still a part of College and anaesthesia. This discussion included an example culture. where a young patient experienced permanent brain damage by a practitioner who had disregarded many After providing some quotations of statements made of the most basic requirements yet was permitted to to the inquiry by leaders in the profession, including remain in the profession. those working for the regulator, the report states:

Page | 3

Legislative Reform developed by them and manages the Board member selection process. In addition to the recommendations described above  The independent oversight body would also some of the more significant recommendations for employ an occupational risk assessment legislative reform for all health regulators include the process that would be used to recommend following: which professions require formal statutory regulation.  Boards be reduced to twelve members, all of whom are appointed (not through the current Conclusion government process) on the basis of demonstrated skills with only half being In summary, the Cayton report contains a detailed members of the profession. review of the performance of the College of Dental  Smaller regulators should be merged into Surgeons of British Columbia. It identified serious fewer, larger ones. deficiencies in the governance of the regulator. It also  A simplified complaints system with three concluded that there were gaps in the regulatory components: triage, investigation, and performance of the regulator in eleven areas. It adjudication. commented on a number of areas for improvement in  An expanded duty to report publicly on all its external relationships with various groups. It operations of the regulator including concluded that the regulator was not focussed complaints outcomes. exclusively on its public interest mandate, particularly  The Review Board should be able to initiate, in the area of public safety. on its own, a review of a complaint outcome even if there is no appeal. The report makes a number of sweeping short term and long term proposals for regulatory reform for all Longer term reforms would include: health professional regulators. These include a completely appointed Board of twelve people, half of  Having a single set of ethical rules and whom are public members, merging regulators, conduct expectations for all health separating out the adjudication of discipline matters professions. and the operation of a single public register, and the  Removing adjudication of disciplinary creation of an oversight agency that would review and disputes from the regulators, to be performed report on the regulatory performance of the by an independent body. regulators.

 That same independent body would also This report is broadly consistent with recent maintain a single register of every health practitioner in the province. developments in British Columbia, and other provinces including Ontario and Nova Scotia and the  There should be a separate independent regulatory regime that has existed in Quebec for oversight body that reviews the performance many years. of regulators, approves some of the standards

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The Cayton Report can be found at: https://www2.gov.bc.ca/assets/gov/health/practitioner -pro/professional-regulation/cayton-report-college-of- dental-surgeons-2018.pdf.

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MEMORANDUM

TH SUBJECT: 25 ANNIVERSARY TO Council FROM Laura Bartolini

DATE May 17, 2019 MEETING DATE June 6, 2019

INTRODUCTION

In 2019, the College of Audiology and Speech-Language Pathology of Ontario (CASLPO) is celebrating its 25th year as a Health Professions Regulatory College. We have rolled-out, many activities to date with several more scheduled for the remainder the year. Our campaign promotes public awareness and engages our members to celebrate with us.

PLANNED ACTIVITIES JANUARY – MAY 2019 • Logos, electronic banners, web page developed • Posted 1st CASLPO Annual Report and Newsletter from 1994 • 25th Anniversary article in February ex.press • E-blasts sent to members and postings to Facebook • Posted letter of congratulations from the Minister of Health and LTC to the website • Live Webinar o Hosted a live webinar with Richard Steinecke with the theme “Yesterday, Today and Tomorrow: A Look Back and a Look ahead for Self-Regulation of Auds And SLPs in Ontario” covering three areas: • How did Auds and SLPs become self-regulated 25 years ago; • how have the regulatory colleges and CASLPO evolved and developed over the last 25 years; and, • What does the future hold for self-regulation in Ontario – challenges and opportunities, and what is the likely government agenda. • Grants

CASLPO selected and awarded a grant of unrestricted funds to 2 organizations that advocate on behalf of their members to improve awareness and legislation that impacts issues for those with communication disorders. The selection process was determined to select the recipients by developing criteria with input from the Patient Relations Committee, and staff including the Practice Advisor for Audiology. A list of potential recipients was compiled that met the following criteria: • Represent a communication impairment group • Do not promote specific treatment approaches, or products • Not-for-profit agency • Charitable status

The grant recipients were selected by the Registrar and Deputy Registrar. They are: Canadian Hard of Hearing Association (CHHA), who advocate on behalf of their members to improve awareness and legislation that impacts issues for those with hearing loss, and;

CASLPO●OAOO Page 1 of 2 Ontario Association for Families of Children with Communication Disorders (OAFCCD), who advocate on behalf of their members to improve awareness and legislation that impacts issues for families in Ontario with children that have communication disorders. The recipients were notified by email and formal letter on April 24, 2019.

ACTIVITIES UNDERWAY FOR JUNE – DECEMBER 2019

• 3 more Then & Now shareables to be sent to members in an eblast and posted to the web and Facebook • Article in ex.press – Fall edition • Year-End messages from the President and Registrar

The budget is expected to be $2,000 less then the $20,000 allocated.

CASLPO●OAOO Page 2 of 2 MEMORANDUM

REVISIONS TO THE POSITION STATEMENT ON PROFESSIONAL RELATIONSHIPS & BOUNDARIES

TO Council

FROM Preeya Singh, Director of Professional Conduct & General Counsel DATE May 29, 2019 MEETING DATE June 6, 2019

Requested Action

The Council is asked to approve the attached revised Position Statement on Professional Relationships and Boundaries.

Background

The Regulated Health Professions Act, 1991 (RHPA) requires that the patient relations program of the College must include measures for preventing and dealing with sexual abuse of patients.

PATIENT RELATIONS PROGRAM

84 (1) The College shall have a patient relations program. 1991, c. 18, Sched. 2, s. 84 (1).

MEASURES FOR SEXUAL ABUSE OF PATIENTS

(2) The patient relations program must include measures for preventing and dealing with sexual abuse of patients. 1993, c. 37, s. 22 (1); 2007, c. 10, Sched. M, s. 60 (1).

SAME

(3) The measures for preventing and dealing with sexual abuse of patients must include,

(a) educational requirements for members; (b) guidelines for the conduct of members with their patients; (c) training for the College’s staff; and

CASLPO●OAOO Page 1 of 2 (d) the provision of information to the public. 1991, c. 18, Sched. 2, s. 84 (3); 1993, c. 37, s. 22 (2); 2007, c. 10, Sched. M, s. 60 (2).

A component of CASLPO’s Sexual Abuse Prevention Program (SAPP) is the Position Statement on Professional Relationships and Boundaries. In our review of recent changes to the RHPA, the attached Position Statement was revised to incorporate the new definition of “patient”.

As of May 1, 2018, the definition of sexual abuse was expanded to include engaging in a sexual relationship with a patient (1) during the treatment relationship and/or (2) within one year of the treatment relationship ending. The RHPA now states:

“patient”, without restricting the ordinary meaning of the term, includes,

(a) an individual who was a member’s patient within one year or such longer period of time as may be prescribed from the date on which the individual ceased to be the member’s patient, and

(b) an individual who is determined to be a patient in accordance with the criteria in any regulations made under clause 43 (1) (o) of the Regulated Health Professions Act, 1991; (“patient”)

The Patient Relations Committee has undertaken an extensive review of the Position Statement. Changes have included the use of simplified language to make it more patient focused and a re-organization to place emphasis on important information. Further, a new section has been included which discusses the ending of a treatment relationship, to provide the membership with guidance in the event that a boundary is crossed. The Inquiries, Complaints and Reports Committee has also reviewed the revised Position Statement to provide its opinion as to whether the document can provide helpful guidance when evaluating relevant cases.

At its April 29, 2019 meeting, the Patient Relations Committee approved the revisions and asked that the Position Statement be referred to Council for approval and publication.

Documents

The following documents are attached for your review:

Item Description 01 Current Position Statement on Professional Relationships and Boundaries 02 Revised Position Statement on Professional Relationships and Boundaries *Please note: highlighted sections within the revised Position Statement (item 02) indicate new sections, however the Position Statement has been edited it in its entirety.

CASLPO●OAOO Page 2 of 2 POSITION STATEMENT

PROFESSIONAL RELATIONSHIPS AND BOUNDARIES

APPROVED 2001 REVISED 2013 REFORMATTED May 2014

Members must treat patients/clients with sensitivity while respecting the boundaries of a health care relationship. Care must be taken to recognize potential violations of professional relationships and to maintain appropriate behaviour.

BACKGROUND

The intent of the Professional Relationships and Boundaries Position Statement is to assist members and patients/clients to:  identify risks and increase awareness of situations in which sexual involvement or other boundary issues might occur;

 prevent inappropriate interaction between the patient/client and the member;  establish and maintain professional boundaries; and  increase members’ awareness of patient/client centred issues such as culture, disability and age-related factors.

This document is intended to assist in the interpretation of the Regulated Health Professions Act, 1991, and the College’s Code of Ethics and Professional Misconduct Regulation, by providing clear definitions and examples of CASLPO’s expectations of professional conduct in the practice of speech- language pathology and audiology. The Professional Relationships and Boundaries document is one component of CASLPO’s Sexual Abuse Prevention Program. Please refer to that document for the complete program.

GUIDING PRINCIPLES

Interpersonal relationships are inherent in the interactions between a member and his or her patients/clients during the management of communication disorders. However, the member must always consider the impact of the relationship on the therapeutic needs of the patient/client. The member possesses unique knowledge and skills upon which the patient/client must rely. This places the audiologist or speech- language pathologist in a position of power relative to the patient/client. This power imbalance is inherent in every relationship between a member and a patient/client and can make the patient/client vulnerable to abuse or boundary violations. The member must always be sensitive to the possibility that the professional relationship may create vulnerability or dependency on the part of the patient/client. It is the responsibility of the member to ensure that a therapeutic relationship is appropriately established and maintained. The member should empower the patient/client to become an active participant in their care, thereby

reducing the power imbalance. Patients/clients must be confident that the services provided will be free of abuse of any kind. The responsibility always falls on the audiologist or speech-language pathologist to recognize issues of power and control, respect physical and emotional boundaries and practise in a manner that preserves the patient’s/client’s trust. The member possesses the knowledge, skills and insight regarding situations and factors that may lead to abuse, and is therefore responsible for preventing abuse. Boundaries help both the member and the patient/client by ensuring that words and actions will not be misinterpreted by the member or patient/client, so that there are clear distinctions between appropriate and inappropriate behaviour. Boundary violations are warning signs that the power balance is not being respected. It is important for the member to examine their practice to identify areas in which they may be vulnerable to allegations of abuse or member misconduct due to unclear boundaries. For example, different cultures may have different values and attitudes towards therapeutic practice. These differences in values and attitudes may result in misinterpretation of behaviour or comments in the context of the therapeutic relationship. It is always the responsibility of the member to preserve professional boundaries, no matter what the patient’s/client’s behaviour.

COMPONENTS OF A THERAPEUTIC RELATIONSHIP Therapeutic relationships are different from non-professional, casual, social and personal relationships. In a therapeutic relationship, the patient/client and their needs are foremost. It is expected that the member will not exploit the professional relationship for the fulfillment of personal gain or needs. Power, trust, respect and physical closeness are components that professionals must consider when managing the boundaries of the relationship.

A) POWER A therapeutic relationship implies an inherent imbalance of power due to the professional’s authority in the health care system, their unique knowledge and the patient’s/client’s dependence on the care provided. Audiologists and speech-language pathologists can also influence other health care providers and payers, have access to confidential information and have the ability to influence decisions about the patient’s/client’s care. Patients/clients may not want to compromise the relationship by challenging the knowledge and expertise of the member. Some patients/clients may feel vulnerable in a relationship that creates dependence on the professional and requires trust that the member will act in his or her best interest. The onus is on the audiologist or speech-language pathologist to recognize this inherent vulnerability and power imbalance and create an environment in which the patient/client feels safe and free to ask questions.

B) TRUST The therapeutic relationship is characterized by the inherent vulnerability of patients/clients. They assume that the clinician has the requisite knowledge, abilities, skills and competence to provide quality care. Clinicians have a responsibility not to harm or exploit the patient/client and to act in the patient’s/client’s best interests. It is very difficult to re-establish trust once it has been breached.

C) RESPECT Audiologists and speech-language pathologists have a responsibility to understand and respect individuals regardless of differences in background, such as those involving gender, sexual orientation, cultural, spiritual, physical, social, environmental, moral, ethical, economical, educational, political and ethnic variations. Members must act in a way that is respectful of the patient’s/client’s participation in his or her care.

D) CLOSENESS The therapeutic relationship places individuals in an atmosphere requiring physical, emotional and psychological closeness that is not usually encountered in relationships in everyday life. The nature and degree of closeness inherent in members’ intervention differs from the closeness of social, romantic or sexual relationships. Closeness may include physical closeness during examinations, disclosure of sensitive personal information and expression of deep-rooted emotions. These practices are acceptable when carried out appropriately, but they do carry a greater degree of closeness that may further deepen a patient’s/client’s feelings of vulnerability. Members must practice with sensitivity, respecting patients’/clients’ autonomy and ensuring that patients/clients are informed and share control in decisions about their care.

LEGAL CONSTRAINTS ON PRACTICE

Members must comply with the laws and regulations governing the practice of audiology and speech-language pathology in the province of Ontario. Discrimination on the basis of citizenship, race, place of origin, ethnic origin, colour, ancestry, disability, age, creed, sex/pregnancy, family status, marital status, sexual orientation, gender identity, gender expression, receipt of public assistance, or record of offence is not permitted in any relationship with patients/clients, families, colleagues or others. Speech-language pathologists and audiologists have an obligation to ensure that patients/clients receive an appropriate explanation for all care provided and that they understand and have consented. Using communication techniques that account for the patient’s/client’s level of communication, language proficiency and cultural orientation is essential1. In all situations, informed consent must be obtained from the patient/client or substitute decision maker as appropriate. Members must respect the patient’s/client’s right to participate in all treatment decisions. Patients/clients must be assured that they may withdraw consent at any time. Members are responsible for obtaining the patient’s/client’s permission for staff, students, or others to observe any aspect of patient/client care. Member’s must document both the giving of consent and its withdrawal in the patient/client record and include reasons given, where possible. Finally, members must refrain from engaging in sexual relationships with patients/clients. Under the Regulated Health Professions Act, 1991, any form of sexual relations (including remarks or behaviour of a sexual nature) between a member of a health regulatory college and a patient/client constitutes sexual abuse.

PROFESSIONAL CONSTRAINTS ON PRACTICE

Members must accept responsibility for the practice of their profession and exercise sound judgement. Members are responsible for ensuring that their own competence and skills, and those of students and supportive personnel working under their supervision, are sufficient to provide quality services. Audiologists and speech-language pathologists need to be aware of situations and factors that may lead to abuse or allegations of misconduct. The member must ensure that all procedures including assessment, treatment planning and implementation reflect care and concern for the patient’s/client’s well-being, comfort, and dignity. When appropriate, patients/clients should be offered choices about how they are to be touched or treated and by whom. It is good practice to always ask a patient’s/client’s permission before touching him/her and to explain the purpose of the procedure. The member must respect and be sensitive to the fact that patients/clients of all ages represent a diversity of cultural, religious, disability and socio- economic backgrounds. See the College’s “Position Statement on Service Delivery to Culturally and Linguistically Diverse Populations”. The member must refrain from making any comments, remarks or gestures that may be interpreted as sexual or demeaning. This includes telling jokes or stories of an offensive nature to the patient/client, and making comments about a patient’s/client’s body, clothing, race, culture, sexual orientation etc. The member should refuse to participate in such discussions initiated by the patient/client. The maintenance of accurate records is important for the protection of both the member and patient/client. For example, recording the giving (or withdrawal) of consent, descriptions of procedures performed, patient’s/client’s reactions, results, etc. will be helpful if allegations or suspicions of abuse arise in the future. The College’s proposed Records Regulation provides specific requirements for making and keeping records, which must always be secure and confidential.

BOUNDARIES IN DIFFERENT TYPES OF RELATIONSHIPS

Relationships between a member and a patient/client and his/her significant others (defined for the purposes of this document as anyone of emotional significance to the patient/client. See Glossary, below, for examples) can take a variety of forms.

A) SEXUAL OR ROMANTIC RELATIONSHIPS Under no circumstances should an audiologist or speech-language pathologist engage in a sexual relationship with a current patient/client or their significant other. A sexual relationship with a former patient/client or the patient’s/client’s significant other is never appropriate if the member uses or exploits trust, knowledge, emotions or influence derived from the therapeutic relationship. The patient’s/client’s willingness or the willingness of the patient’s/client’s significant other to participate in such a relationship does not absolve the member of their legal and ethical obligations. The following guidelines are intended to assist members with appropriate handling of situations in which a romantic or sexual relationship may arise2.

1) A patient/client in treatment attempts to initiate a romantic or sexual relationship: • The patient/client should be made aware of the ethical and legal restrictions of the member. Members should communicate clearly the appropriate professional boundaries for the therapeutic relationship. • The patient/client must be referred to another audiologist/speech-language pathologist if either the member or the patient/client is having problems dealing with feelings of attraction, or if attempts to resolve the situation have been unsuccessful. • It is appropriate for the member to seek advice from supervisors, qualified members of the profession or the College. • Issues which arise and actions taken should be documented.

2) A romantic or sexual relationship develops with a patient/client after discharge When deciding whether it is acceptable to become involved in a romantic or sexual relationship with a patient/client after the therapeutic relationship has ended, members are expected to exercise good judgement and to adhere to the following guidelines in making the decision: • An interval of sufficient duration must have elapsed between the documented end of the therapeutic relationship and the time a member pursues a romantic relationship with a former patient/client or his/her significant other. Any determination by a member of whether or not an interval of sufficient duration has elapsed must include consideration of, among other factors: o The patient’s/client’s vulnerability or degree of emotional dependence on the audiologist or speech-language pathologist as a result of the professional relationship; o The duration and frequency of treatment;

o The nature of the intervention;

o The amount and nature of the patient’s/client’s disclosure of personal

information; and o The ability of the patient/client to act freely.

• If the patient/client still requires professional services, or will require them in the future, the member should ensure that all care or management has been transferred to another audiologist or speech-language pathologist before any romantic or sexual relationship starts. The member should ensure that the patient/client understands and acknowledges that the therapeutic relationship has concluded and documents the same in the patient/client record at discharge. • There may be times when it is never appropriate to start a romantic or sexual relationship with a former patient/client, regardless of how long ago the treatment relationship ended. This may be the case even if the decision to avoid a romantic or sexual relationship is disappointing or upsetting to the member and/or the patient/client.

B) OTHER PERSONAL RELATIONSHIPS

The issue of boundaries is broader than sexual abuse, covering such topics as family relationships, financial dealings, conflict of interest, and breach of confidentiality. Boundary concerns can arise when a member treats a close friend or family member, neighbour or colleague or others with whom the member has a personal relationship. A boundary violation can occur whether the member intended it to or not. Regardless of the intention, the violation can have serious negative effects on both the patient/client and the member. Casual or social relationships outside of the therapeutic relationship may be acceptable where the relationship has a neutral or positive effect on the therapeutic relationship. A casual or social relationship outside of the therapeutic relationship, which has or may have a negative effect on the therapeutic relationship, is not acceptable.

C) WARNING SIGNS WHICH MAY INDICATE THAT PROFESSIONAL BOUNDARIES MIGHT BE CROSSED:

 Deliberately scheduling patient/client sessions to take place at a time when others are likely to not be present such as early or late appointments, particularly when this has not been requested by the patient/client or is unrelated to therapeutic needs  Deliberately and consistently extending therapeutic sessions beyond the scheduled time  Conversations with the patient/client outside of the therapeutic environment unrelated to the patient’s/client’s treatment  Excessive self-disclosure to a patient/client  Exchange of expensive or personal gifts with patient/client  Deliberately meeting or attempting to meet socially with the patient/client  Experiencing feelings of mutual or one-sided attraction to the patient/client  The member lends money to the patient/client or vice versa  Extending credit to the patient/client beyond the member’s customary practice  Providing preferential treatment to the patient/client to the detriment of other patients/clients (e.g. cancelling appointments to “fit-in” the patient/client)  The patient/client asks the member to do something that may be unethical or illegal (e.g. provide a false receipt for services)  Offering to help a patient/client with something outside of the therapeutic relationship or to provide therapeutic services beyond the member’s knowledge and skills

Members should examine the nature of the professional relationship with a patient/client if any of these or other warning signs are present. Members must be aware of behaviours and situations that could lead to or be perceived as crossing professional boundaries.

CONSEQUENCES OF BOUNDARY VIOLATIONS

BOUNDARY CROSSINGS occur when the behaviour of a member deviates from the prescribed boundaries of a therapeutic relationship. Some behaviours (e.g. gift-giving, self- disclosure, accepting gifts, treatment of friends or family members) are not normally a part of intervention and are generally inappropriate. However, there are situations that fall into grey zones, when normally inappropriate behaviours are acceptable if they meet the patient’s/client’s needs and established goals. BOUNDARY VIOLATIONS are behaviours on the part of the member that are inappropriate and violate the nature of the therapeutic relationship. These behaviours do not contribute to the established treatment goals. Some of the possible negative consequences of boundary violations are:  the patient/client or the member may make decisions about treatment that are not in the best interests of the patient/client  the member may lose objectivity with respect to the patient/client  the patient/client may not respect the advice and recommendations of the member in the same way he or she would with a care provider they do not know as well

MANAGING BOUNDARY CROSSINGS

There are times when an audiologist or speech-language pathologist may intentionally cross a professional boundary for the betterment of the therapeutic relationship. When the actions fall out of what is typical, the member needs to reflect upon the following questions prior to engaging in the atypical activity:

 Am I doing something that my patient/client needs in order to achieve our agreed upon treatment goals?  Do my actions have the potential for confusing the patient/client and could they be perceived to be inappropriate in a therapeutic relationship?  Will my actions cause the patient/client to expect more services than are routinely provided or beyond my treatment mandate?  Can other resources be utilized to meet this need?  Would I tell a colleague about this activity?  Are my behaviours similar to those of other practitioners in the same circumstances?  Who benefits the most from performing these tasks?  Is the payer aware that an audiologist or speech-language pathologist is performing these activities? Would the payer fund them as part of the plan of care?

GLOSSARY

THE COLLEGE refers to the College of Audiologists and Speech-Language Pathologists of Ontario or CASLPO

PATIENT/CLIENT Refers to any members of the public who use the services of audiologists and speech-language pathologists.

SIGNIFICANT OTHERS means a person or persons of emotional significance to the patient/client. This includes, but is not limited to, a patient/client’s spouse, parent or sibling, and, in the case of a minor or incompetent patient/client, the parent, guardian or person responsible for the care of the minor or incompetent patient/client.

MEMBER audiologists and speech-language pathologists who are CASLPO members

RESOURCES

College of Audiologists and Speech-Language Pathologists (1996). Ontario Regulation 749/93: Professional Misconduct.

College of Audiologists and Speech-Language Pathologists (2011). By-law No. 8, 2011-8 Code of Ethics .

College of Audiologists and Speech-Language Pathologists (1996). Conflict of Interest Regulation (draft).

College of Dieticians of Ontario Guidelines for the Conduct of Professional Members on the Prevention of Sexual Abuse.

Peters, Martin (1993). Preventing sexual abuse in health care: Criminal law aspects and issues. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute.

Rankin, Elizabeth (1993). The dynamics of sexual abuse in member relationships…and the theory of dynamic relations as origin of disease is both cause and effect. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute.

Ross, Margaret. (1993). Risk management for health care members. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute.

College of Physical Therapists of Alberta: “Therapeutic Relationships: Establishing and Maintaining Professional Boundaries: A resource guide for physical therapists”.

FOR MORE INFORMATION

Please feel free to contact the College by mail, phone, fax or e-mail if you have questions regarding this or other College publications. The College’s Director of Professional Conduct can be contacted by email at [email protected] or by phone at 416-975-5347 ext. 221, or toll free at 1-800-993-9459 ext. 221. The College’s Registrar can be contacted by email at [email protected] or by phone at 416- 975-5347 ext. 215, or toll free at 1-800-993-9459 ext. 215.

College of Audiologists and Speech-Language Pathologists of Ontario Position Statement – PROFESSIONAL RELATIONSHIPS AND BOUNDARIES

PROFESSIONAL RELATIONSHIPS AND BOUNDARIES POSITION STATEMENT DRAFT

5060-3080 Yonge Street Toronto, Ontario M4N 3N1 APPROVED: 2001; 2013 (REVISED) 416-975-5347 1-800-993-9459 www.caslpo.com EFFECTIVE: REVISED – EFFECTIVE:

TABLE OF CONTENTS Introduction ...... 1 Background ...... 1 Guiding Principles ...... 2 Legal Constraints on Practice ...... 3 Components of a Therapeutic Relationship ...... 4 Professional Constrains on Practice ...... 5 Boundaries in Difference Types of Relationships ...... 6-8 A) Sexual Relationship ...... 6-7 B) Other Personal Relationships ...... 8 Consequences of Boundary Violations ...... 8 Concluding the Treatment Relationship ...... 9 Glossary...... 9-10 Resources ...... 11 More Information ...... 11 Appendix A: Guide for Managing Professional Relationships and Boundaries ...... 12-13

CASLPO•OAOO

INTRODUCTION

Audiologists (“AUDs”) and Speech-Language Pathologists (“SLPs”) must treat patients with sensitivity while respecting the boundaries of a health care relationship. Serious care must be taken to recognize potential violations of professional relationships and to maintain appropriate behaviour.

BACKGROUND

The intent of the Professional Relationships and Boundaries Position Statement is to assist patients and AUDs and SLPs to: • identify risks and increase awareness of situations in which sexual involvement or other boundary issues might occur;

• prevent inappropriate interaction between the patient and AUD or SLP; and • establish and maintain professional boundaries.

This document is intended to assist in the interpretation of the Regulated Health Professions Act, 1991 (“RHPA”), and the College’s Code of Ethics, Guide for Service Delivery Across Diverse Cultures, and Professional Misconduct Regulation, by providing clear definitions and examples of CASLPO’s expectations of professional conduct in the practice of speech- language pathology and audiology. The Professional Relationships and Boundaries document is one component of CASLPO’s Sexual Abuse Prevention Program. Please refer to that document for the complete program.

GUIDING PRINCIPLES

A) INTERPERSONAL RELATIONSHIPS B) POWER IMBALANCE Health care relationships can include both A power imbalance is inherent in every the therapeutic and interpersonal treatment relationship and can make the relationship. However, because of the patient vulnerable to abuse or boundary nature of the therapeutic relationship, the violations. The AUD or SLP must always AUD or SLP possesses unique knowledge be sensitive to the possibility that the and skills upon which the patient must professional relationship may create rely and this places the AUD or SLP in a vulnerability or dependency on the part of position of power over the patient. the patient.

C) RESPONSIBILITY D) BOUNDARIES It is the responsibility of the A U D o r Boundaries help both the patient and the AUD SLP to ensure that a therapeutic or SLP by ensuring that words and actions will relationship is appropriately established, not be misinterpreted by the patient or the maintained and concluded. Patients AUD/SLP, so that there are clear distinctions should be encouraged to become active between appropriate and inappropriate participants in their care, thereby behaviour. Boundary violations are warning reducing the power imbalance. signs that the power imbalance is becoming concerning.

Boundary violations occur when the behaviour of an AUD or SLP deviates from the prescribed boundaries of a therapeutic relationship. Some behaviours (e.g. gift-giving, self-disclosure, accepting gifts, treatment of friends or family members) are not normally a part of intervention and are generally inappropriate. However, there are situations that fall into grey zones, when normally inappropriate behaviours are acceptable if they meet the patient’s needs and established goals. It is always the responsibility of the AUD or SLP to preserve professional boundaries, no matter what the patient’s behavior.

LEGAL CONSTRAINTS ON PRACTICE

A) SEXUAL ABUSE B) DISCRIMINATION AUDs and SLPs must not engage in sexual AUDs and SLPs must comply with the laws relationships with patients. Under the RHPA, and regulations governing the practice of any form of sexual relations (including all audiology and speech-language pathology in physical sexual relations, touching of a the province of Ontario. Discrimination sexual nature, or remarks or behaviour of a based on citizenship, race, place of origin, sexual nature) between a patient and AUD or ethnic origin, colour, ancestry, disability, age, SLP constitutes sexual abuse. creed, sex/pregnancy, family status, marital status, sexual orientation, education, gender identity, gender expression, receipt of public assistance, or record of offence is not permitted in any relationship with patients, families, colleagues or others. C) INFORMED CONSENT1 AUDs and SLPs have an obligation to ensure that patients receive an appropriate explanation for all care proposed and that they understand and have consented. Communication techniques that account for the patient’s level of communication, language proficiency and cultural orientation is essential. In all situations, informed consent must be obtained from the patient or substitute decision maker as appropriate to each patient. AUDs and SLPs must respect the patient’s right to participate in all treatment decisions, which includes the right to give, withhold or withdraw consent. AUDs and SLPs are responsible for obtaining the patient’s permission for staff, students, family, or others to observe any aspect of patient care. AUDs and SLPs must document in the patient record both the giving of consent and its withdrawal and include reasons given, where possible.

1 For more information, please refer to the College’s Guide on Obtaining Consent for Services.

COMPONENTS OF A THERAPEUTIC RELATIONSHIP

In a therapeutic relationship, the patient and their needs are foremost. It is expected that the AUD or SLP will not exploit the professional relationship for the fulfillment of personal gain or needs. Power, trust, respect and physical proximity are components that AUDs and SLPs must consider when managing the boundaries of the relationship.

A) POWER

Through a patient centered approach, it is the responsibility of the AUD or SLP to recognize the inherent vulnerability and power imbalance of the therapeutic relationship and to create an environment in which the patient feels safe and free to ask questions. A therapeutic relationship implies an inherent imbalance of power due to: 1. the professional’s authority in the health care system, 2. their unique knowledge, 3. the patient’s (or family member’s) vulnerability, and 4. the patient’s dependence on the care provided. AUDs and SLPs can also influence other health care providers and payers of services, are provided confidential information as trusted health care providers and can influence decisions about the patient’s care.

Patients may not want to compromise the relationship by challenging the knowledge and expertise of the AUD or SLP. Some patients may feel vulnerable in a relationship that creates dependence on the professional and requires trust that the member will act in his or her best interest. Patients must also be assured that they may withdraw consent at any time.

B) TRUST

When seeking health care services, many patients feel vulnerable and seek a professional whom they trust has the requisite knowledge, skill and competence to provide quality care. They may divulge personal information which increases their vulnerability and so AUDs and SLPs must not harm or exploit the patient and to act in the patient’s best interests.

C) RESPECT

As a requirement of CASLPO’s Code of Ethics, AUDs and SLPs have an ethical obligation to respect individuals regardless of differences in background, such as those involving gender, sexual orientation, cultural, spiritual, physical, social, environmental, moral, ethical, economical, educational, political and ethnic variations. AUDs and SLPs must act in a way that is respectful of the patient’s participation in his or her care.

D) CLOSENESS

The therapeutic relationship places individuals in a situation requiring physical, emotional and psychological closeness that is not usually encountered in relationships in everyday life. This differs from the closeness of social, romantic or sexual relationships. Closeness may include: → physical touch of the face, ears, mouth, neck chest and stomach, → physical proximity during examinations, → disclosure of sensitive personal information, and → expression of deep-rooted emotions.

These practices are acceptable when carried out appropriately, but they do carry a greater degree of closeness that may further deepen a patient’s feelings of vulnerability. AUDs and SLPs must practice with sensitivity, respecting patients’ autonomy and ensuring that patients are informed and share control in decisions about their care.

PROFESSIONAL CONSTRAINTS ON PRACTICE

AUDs and SLPs need to be aware of situations and factors that may lead to abuse or allegations of misconduct. AUDs and SLPs must ensure that all procedures including assessment, treatment planning and implementation reflect care and concern for the patient’s well-being, comfort, and dignity. A) TOUCH B) DIVERSITY When appropriate, patients should be offered AUDs and SLPs must respect and be choices about how they are to be touched responsive to the fact that patients of all ages or treated and by whom. It is always good represent a diversity of backgrounds. practice to ask a patient’s permission before touching him/her and to explain the purpose of the procedure. C) COMMUNICATION AUDs and SLPs must refrain from making any comments, remarks or gestures that may be interpreted as sexual or demeaning. This includes telling jokes or stories of an offensive nature to the patient, and making comments about a patient’s body, clothing, race, culture, sexual orientation, etc. AUDs and SLPs must not participate in such discussions initiated by the patient.

Please refer to Appendix A for the Guide to Managing Professional Relationships and Boundaries for guidance on managing boundaries. AUDs and SLPs also have the option of contacting practice advice for further information.

BOUNDARIES IN DIFFERENT TYPES OF RELATIONSHIPS

Relationships between a patient and AUD or SLP and his/her significant others can take a variety of form. For the purposes of this document, a “significant other” is anyone who is closely associated with the patient. See Glossary for examples. A) SEXUAL OR ROMANTIC RELATIONSHIPS

Under no circumstances should an AUD or SLP engage in a sexual relationship with a current patient or their significant other. Further, AUDs and SLPs must not provide treatment to their spouse or common law partner. Under the RHPA, spousal relationships are not exempted from the definition of sexual abuse. For the purposes of sexual abuse, the RHPA defines a patient as: (a) an individual who was a member’s patient within one year or such longer period as may be prescribed from the date on which the individual ceased to be the member’s patient, and

(b) an individual who is determined to be a patient in accordance with the criteria in any regulations made under clause 43 (1) (o) of the Regulated Health Professions Act, 1991; (“patient”) Engaging in a sexual relationship with a patient within one (1) year of the therapeutic relationship ending is considered sexual abuse of a patient. If found guilty of engaging in sexual abuse, a panel of the Discipline Committee is required to revoke a member’s certificate of registration, which cannot be subject to a re-registration hearing for a period of five (5) years. A sexual relationship with a former patient (longer than one-year post treatment relationship) is never appropriate if the member uses or exploits trust, knowledge, emotions or influence derived from the therapeutic relationship. The patient’s willingness or the willingness of the patient’s significant other to participate in such a relationship does not absolve the AUD or SLP of their legal and ethical obligations.

The following guidelines are intended to assist AUDs and SLPs with appropriate handling of situations in which a romantic or sexual relationship may arise.

1) A patient in treatment attempts to initiate a romantic or sexual relationship:

• The patient should be made aware of the ethical and legal restrictions of the AUD or SLP. AUDs and SLPs should communicate clearly the appropriate professional boundaries for the therapeutic relationship. • The patient must be referred to another AUD/SLP if either the patient or the AUD/SLP is having problems dealing with feelings of attraction, or if attempts to resolve the situation have been unsuccessful. • It is appropriate for the AUD or SLP to seek advice from supervisors, experienced members of the profession, or the College. • Issues which arise, and actions taken should be documented.

2) A romantic or sexual relationship develops with a patient after discharge

• If, after the passage of one year, the patient and AUD or SLP wish to engage in a sexual relationship, the audiologist or SLP should consider: o The patient’s vulnerability or degree of emotional dependence on the AUD or SLP as a result of the professional relationship; o The duration and frequency of treatment;

o The nature of the intervention;

o The amount and nature of the patient’s disclosure of personal

information; and o The ability of the patient to act freely.

• There may be times when it is never appropriate to start a romantic or sexual relationship with a former patient. This may be the case even if the decision to avoid a romantic or sexual relationship is disappointing or upsetting to the member and/or the patient. It is important to document the steps that have been taken.

B) OTHER PERSONAL RELATIONSHIPS

The issue of boundaries is broader than sexual abuse, covering such topics as family relationships, financial dealings, conflict of interest, and breach of confidentiality. Boundary concerns can arise when an AUD or SLP treats a close friend or family member, neighbour or colleague or others with whom the AUD or SLP has a personal relationship. A boundary violation can occur whether the AUD or SLP intended it to or not. Regardless of the intention, the violation can have serious negative effects on both the patient and AUD/SLP. Casual or social relationships outside of the therapeutic relationship may be acceptable where the relationship has a neutral effect on the therapeutic relationship.

Please refer to Appendix A for the Guide to Managing Professional Relationships and Boundaries which discusses warning signs that professional boundaries may have been crossed.

CONSEQUENCES OF BOUNDARY VIOLATIONS

BOUNDARY VIOLATIONS are behaviours on the part of the AUD or SLP that are inappropriate and violate the nature of the therapeutic relationship. These behaviours do not contribute to the established treatment goals. Some of the possible negative consequences of boundary violations are: • the patient or AUD/SLP may make decisions about treatment that are not in the best interests of the patient • AUD or SLP may lose objectivity with respect to the patient • the patient may not respect the advice and recommendations of the AUD or SLP in the same way he or she would with a care provider they do not know as well • AUD or SLP may be found guilty of sexual abuse (as defined by the RHPA) and therefore loose their certificate of registration to practice in Ontario

CONCLUDING THE TREATMENT RELATIONSHIP

In some circumstances, the feelings of the patient and/or AUD/SLP may impact the treatment relationship to the extent that continuing with treatment is not in the patient’s best interest. In those circumstances, the AUD or SLP should: • Stop providing treatment to the patient (document reasons in the patient record); • Advise the patient of the reasons that treatment must be discontinued; • Advise the patient that continuing with their care would not be in their best interest; and • Provide the contact information for alternative service providers if treatment is still necessary.

It is important to ensure that, in concluding the treatment relationship, the impact to the patient’s care is minimized as much as possible. Even if the patient consents to continue with treatment, AUDs and SLPs must use their professional judgement to ensure that the best interest of the patient is protected.

GLOSSARY THE COLLEGE Refers to the College of Audiologists and Speech-Language Pathologists of Ontario or CASLPO

PATIENT Refers to any person who receives services from an audiologist or speech-language pathologist registered with CASLPO.

SIGNIFICANT OTHERS A person or persons of emotional significance to the patient. This includes, but is not limited to, a patient’s spouse, parent, sibling or adult child, and, in the case of a minor or incompetent patient, the parent, guardian or person responsible for the care of the minor or incompetent patient.

MEMBER

Audiologists and Speech-language Pathologists who are registered members of CASLPO

RESOURCES

Regulated Health Professions Act (1991) College of Audiologists and Speech-Language Pathologists (1996). Ontario Regulation 749/93: Professional Misconduct. College of Audiologists and Speech-Language Pathologists (2011). By-law No. 7, Code of Ethics. College of Audiologists and Speech-Language Pathologists (1996). Conflict of Interest Regulation (draft). Peters, Martin (1993). Preventing sexual abuse in health care: Criminal law aspects and issues. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute. Rankin, Elizabeth (1993). The dynamics of sexual abuse in member relationships…and the theory of dynamic relations as origin of disease is both cause and effect. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute. Ross, Margaret. (1993). Risk management for health care members. Preventing Sexual Abuse in Health Care: Preparing for the Impact of Bill 100. Toronto: The Canadian Institute. Physiotherapy Alberta – College + Association. (2017). “Therapeutic Relationships Resource Guide for Alberta Physiotherapists.

McPhedran, Marilou. (2000). What about accountability to the patient? Final Report of the Special Task Force on Sexual Abuse of Patients. Mussani v. College of Physicians and Surgeons of Ontario, 2004 CanLII 48653 (ON CA)

McPhedran, Marilou. (2015). To Zero: Independent Report of the Minister’s Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991. College of Physicians and Surgeons of Ontario Policy Statement: Maintaining Appropriate Boundaries and Preventing Sexual Abuse. (September 2008; reviewed June 2017; May 2018)

FOR MORE INFORMATION

Please feel free to contact the College by mail, phone, fax or e-mail if you have questions regarding this or other College publications. The College’s Director of Professional Conduct & General Counsel can be contacted by email [email protected] or by phone at 416-975-5347 ext. 221, or toll free at 1-800-993-9459 ext. 221. The College’s Registrar can be contacted by email at [email protected] or by phone at 416-975- 5347 ext. 215, or toll free at 1-800-993-9459 ext. 215

APPENDIX A: GUIDE FOR MANAGING PROFESSIONAL RELATIONSHIPS AND BOUNDARIES

EFFECTIVE: [DATE]

Audiologists and Speech-Language Pathologists must treat patients with sensitivity while respecting the boundaries of a health care relationship. Care must be taken to recognize potential violations of professional relationships and to maintain appropriate behaviour.

BACKGROUND

The College’s Position Statement on Professional Relationships and Boundaries sets out the dynamics of the treatment relationship and outlines the various constraints on boundaries when treating patients. The following is intended to provide guidance respecting how audiologists and speech-language pathologists can manage relationships that may be crossing professional lines. WARNING SIGNS WHICH MAY INDICATE THAT PROFESSIONAL BOUNDARIES MIGHT BE CROSSED:

• Deliberately scheduling patient sessions to take place at a time when others are likely to not be present such as early or late appointments, particularly when this has not been requested by the patient or is unrelated to therapeutic needs • Deliberately and consistently extending therapeutic sessions beyond the scheduled time • Conversations with the patient outside of the therapeutic environment unrelated to the patient’s ’s treatment • Excessive self-disclosure to a patient • Exchange of expensive or personal gifts with patient • Deliberately meeting or attempting to meet socially with the patient • Experiencing feelings of mutual or one-sided attraction to the patient • Lends money to the patient or vice versa • Extending credit to the patient beyond the member’s customary practice • Providing preferential treatment to the patient to the detriment of other patients (e.g. cancelling appointments to “fit-in” the patient ) • The patient asks the member to do something that may be unethical or illegal (e.g. provide a false receipt for services)

• Offering to help a patient with something outside of the therapeutic relationship or to provide therapeutic services beyond the member’s knowledge and skills

Audiologists and speech-language pathologists should examine the nature of the professional relationship with a patient if any of these or other warning signs are present. Audiologists and speech- language pathologists must be aware of behaviours and situations that could lead to or be perceived as crossing professional boundaries.

MANAGING BOUNDARIES

When the actions fall out of what is typical, the audiologist/speech-language pathologist needs to reflect upon the following questions prior to engaging in the atypical activity: • Am I doing something that my patient needs to achieve our agreed upon treatment goals? • Do my actions have the potential for confusing the patient and could they be perceived to be inappropriate in a therapeutic relationship? • Will my actions cause the patient to expect more services than are routinely provided or beyond my treatment mandate? • Can other resources be utilized to meet this need? • Would I tell a colleague about this activity? • Are my behaviours similar to those of other practitioners in the same circumstances? • Who benefits the most from performing these tasks? Is the third party payer (e.g. insurance company) aware that an audiologist or speech- language pathologist is performing these activities? Would the payer fund them as part of the plan of care?

MEMORANDUM

REVISIONS TO THE SEXUAL ABUSE PREVENTION PROGRAM

TO Council

FROM Preeya Singh, Director of Professional Conduct & General Counsel DATE May 29, 2019 MEETING DATE June 6, 2019

Requested Action

The Council asked to approve the attached revised Sexual Abuse Prevention Program (SAPP).

Background

The Regulated Health Professions Act, 1991 (RHPA) requires that the patient relations program of the College must include measures for preventing and dealing with sexual abuse of patients:

PATIENT RELATIONS PROGRAM

84 (1) The College shall have a patient relations program. 1991, c. 18, Sched. 2, s. 84 (1).

MEASURES FOR SEXUAL ABUSE OF PATIENTS

(2) The patient relations program must include measures for preventing and dealing with sexual abuse of patients. 1993, c. 37, s. 22 (1); 2007, c. 10, Sched. M, s. 60 (1).

SAME

(3) The measures for preventing and dealing with sexual abuse of patients must include,

(a) educational requirements for members; (b) guidelines for the conduct of members with their patients; (c) training for the College’s staff; and

CASLPO●OAOO Page 1 of 4 (d) the provision of information to the public. 1991, c. 18, Sched. 2, s. 84 (3); 1993, c. 37, s. 22 (2); 2007, c. 10, Sched. M, s. 60 (2).

CASLPO currently has a SAPP which provides guidance for the management of sexual abuse of patients by Audiologists and Speech-Language Pathologists ( “members”). The current SAPP was revised in 2013. Since then, a number of important events have occurred in professional health regulation in regards to sexual abuse. Most notably, the Minister of Health and Long-Term Care (at that time, the Honourable Dr. Eric Hoskins) appointed an independent task force in 2015 to review the RHPA to assess whether it, and the related policies and programs, upheld the zero tolerance standard respecting sexual abuse of patients.

In her final report, “To Zero: Independent Report of the Minister’s Task Force on the Prevention of Sexual Abuse of Patients”, task force Chair, Marilou McPhedran, found:

The need for significant changes was apparent throughout this process. Far too often, the health regulatory colleges have been unable to uphold the zero tolerance standard, and far too many Ontario patients do not have confidence in the current system.1

Ms. McPhedran made a number of recommendations for legislative change to the RHPA, some of which were incorporated into Bill 87, known as the Protecting Patients Act, 2017. As a result of these changes, and the recommendations made by Ms. McPhedran, the revised SAPP contains changes intended to bring the SAPP in line with the recent RHPA amendments and enhance the provisions contained therein. The most notable changes include:

1. New definition of patient for the purposes of sexual abuse.

As of May 1, 2018, sexual abuse includes engaging in a sexual relationship with a patient (1) during the treatment relationship and/or (2) within one year of the treatment relationship ending. From the RHPA:

“patient”, without restricting the ordinary meaning of the term, includes,

(a) an individual who was a member’s patient within one year or such longer period of time as may be prescribed from the date on which the individual ceased to be the member’s patient, and

(b) an individual who is determined to be a patient in accordance with the criteria in any regulations made under clause 43 (1) (o) of the Regulated Health Professions Act, 1991; (“patient”)

1 See To Zero (2015) page ix of Executive Summary.

CASLPO●OAOO Page 2 of 4 Despite the fact the CASLPO does not have an extensive history of sexual abuse cases, this change is of particular importance because a complaint was lodged in 2016 against an SLP which alleged sexual abuse. The SLP engaged in a sexual relationship with the complainant shortly after discharge from care. In CASLPO v. D’Onofrio, the member was found guilty of professional misconduct, but was not found guilty of sexually abusing a patient because the sexual relationship occurred after discharge and the legislative changes were not in effect at that time. The legislative changes increase the likelihood that CASLPO will receive cases that fit within the definition of sexual abuse and so an updated SAPP is needed.

2. Enhancements to the Public Register

The Protecting Patients Act, 2017 also included a number of revisions to information that is now required on the public register. These requirements are in conjunction with the revisions CASLPO Council made to its bylaws in 2015. Changes include the posting of information respecting:

• charges, findings of guilt and conditions of release made under the Criminal Code (Canada) and/or Controlled Drug Substances Act (Canada) • every referral to the Discipline Committee by the Inquiries, Complaints and Reports Committee • interim orders • findings of professional misconduct or incompetence made by other regulators

It is hoped that these changes will give the public more information to help them make informed decisions about their health care. The revised SAPP highlights these changes to demonstrate CASLPO’s commitment to keep the public informed about their health care providers.

3. Enhanced Discipline Rules of Procedure

In August 2017, the Discipline Committee revised its Rules of Procedure in light of one of the recommendations made by the To Zero report. The Task Force recommended increased protections to vulnerable witnesses testifying in sexual abuse cases. Specifically, the Rules of Procedure now include the following Rule:

11.07(6) Where a vulnerable witness is, or will be, testifying regarding allegations of sexual abuse or professional misconduct of a sexual nature, it is presumed to be an appropriate case for the Discipline Committee to make one or more orders under subrules 11.07(1) to 11.07(5) in relation to the testimony of the vulnerable witness, in the absence of evidence to the contrary.

The SAPP now includes reference to this enhanced procedure to demonstrate CASLPO’s commitment to addressing sexual abuse in different ways. The

CASLPO●OAOO Page 3 of 4 commitment to addressing and eradicating sexual abuse must be multidimensional.

The Patient Relations Committee has undertaken an extensive review of the SAPP with a view of enhancing CASLPO’s management of sexual abuse cases. The SAPP is intended to be a document that clearly conveys CASLPO’s zero tolerance position with simplified language. The Inquiries, Complaints and Reports Committee has also reviewed the revised SAPP to provide its opinion as to whether the Program can provide helpful guidance when evaluating relevant cases.

At its April 29, 2019 meeting, the Patient Relations Committee approved the revisions and asked that the SAPP be referred to Council for approval and publication.

Documents

The following documents are attached for your review:

Item Description 01 Current Sexual Abuse Prevention Program 02 Revised Sexual Abuse Prevention Program

*Please note: highlighted sections within the revised SAPP (item 02) indicate new sections, however the SAPP has been edited it in its entirety.

CASLPO●OAOO Page 4 of 4

SEXUAL ABUSE PREVENTION PROGRAM

5060-3080 Yonge Street, Box 71 Revised: March 2013 Toronto, Ontario M4N 3N1 416-975-5347 1-800-993-9459 Reformatted: November www.caslpo.com 2014 SEXUAL ABUSE PREVENTION PROGRAM

SUMMARY

This This Sexual Abuse Prevention Program was developed by the members of CASLPO's Patient Relations Committee. The purpose of the Program is to familiarize audiology and speech-language pathology members of CASLPO (“Members”) and the public with CASLPO's philosophy regarding the sexual abuse of patients/clients and its measures for preventing and dealing with sexual abuse.

March 2013 CASLPO•OAOO i SEXUAL ABUSE PREVENTION PROGRAM

TABLE OF CONTENTS Introduction ...... 1 Statement of Philosophy ...... 2 Guiding Principles ...... 3 Goals and Objectives ...... 4 Guidelines for Professional Conduct of Members ...... 5 Professional Education Program ...... 6 Staff Education ...... 7 Public Education ...... 8 Funding of Therapy and Counselling of Victims ...... 9 Rehabilitation of Members ...... 10 Procedures for Handling Complaints ...... 11 Mandatory Reports ...... 12 Penalties for Sexual Abuse ...... 13 Program Evaluation ...... 14 For More Information ...... 15

March 2013 CASLPO•OAOO CONTENTS SEXUAL ABUSE PREVENTION PROGRAM

INTRODUCTION

Under the Regulated Health Professions Act, 1991, (the “RHPA”) each regulatory health college must have a Patient Relations Committee and a Patient Relations Program. The Patient Relations Program must include measures for preventing and dealing with sexual abuse of patients/clients. More particularly, the program must include educational requirements for Members, guidelines for the conduct of Members with their patients/clients, training for the College’s staff and the provision of information to the public. The College of Audiologists and Speech-Language Pathologists of Ontario has been diligent in its efforts to comply with these requirements. In keeping with the requirement to deal with Members who sexually abuse patients/clients, a variety of measures have been implemented. Staff and council member training on the nature of sexual abuse is provided on an ongoing basis. Intake procedures for complaints are in place and modifications to the procedures have been made for complaints of a sexual nature. A fund to provide counselling for victims of sexual abuse has been established. This Program is the cornerstone of the College’s strategy for preventing sexual abuse. It is intended to acquaint Members with CASLPO's philosophy of "zero tolerance" of sexual abuse and to provide information and direction to Members concerning their protections and obligations under provincial legislation. The Program is also intended to provide a policy foundation for the further development of information resources and procedures to support the goal of eliminating sexual abuse.

March 2013 CASLPO•OAOO PAGE 1 SEXUAL ABUSE PREVENTION PROGRAM

STATEMENT OF PHILOSOPHY

CASLPO maintains that sexual abuse within a therapeutic relationship is unacceptable and will not be tolerated.

March 2013 CASLPO•OAOO PAGE 2 SEXUAL ABUSE PREVENTION PROGRAM

GUIDING PRINCIPLES

Zero Tolerance The term "zero tolerance" refers to the College’s position that sexual abuse of patients/clients by Members of the College will not be tolerated. Sexual Abuse The Health Professions Procedural Code (the Code) of the RHPA defines “Sexual Abuse” in Section 1(3) as follows:  Sexual intercourse or other forms of physical sexual relations between the member and the patient  Touching of a sexual nature of the patient by the member  Behaviour or remarks of a sexual nature by the member towards the patient Prevention CASLPO is committed to the prevention of inappropriate behaviour and demonstrates this commitment by educating its Members and having a discipline process that reflects the seriousness of the violation. Sensitivity CASLPO acknowledges the potential vulnerability of patients/clients and strives to provide a reporting process that is accessible and sensitive to their needs.

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GOALS AND OBJECTIVES

CASLPO's Sexual Abuse Prevention Program has the following goals and objectives:  Provide a strategic focus for the development of programs, procedures, resources and activities aimed at preventing and eliminating sexual abuse  Have measures in place for preventing sexual abuse  Have measures in place for addressing instances of Members sexually abusing patients/clients

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GUIDELINES FOR PROFESSIONAL CONDUCT OF MEMBERS

The Code specifies that measures for preventing and dealing with sexual abuse of patients/clients must include "guidelines for the conduct of members with their patients" (subparagraph 84(3)(b)). The following outlines CASLPO's position with respect to the nature of the professional relationship and basic parameters in regard to professional conduct. For further information, refer to CASLPO’s Position Statement on Professional Relationships and Boundaries. The purpose of the relationship between an audiologist/speech-language pathologist and patient/client is to provide assessment, treatment, and management of communication disorders as defined in the scope of practice and preferred practice guidelines. It is the professional's responsibility to establish a relationship with the patient/client based on trust, support and mutual respect. Sexually abusive behaviour is a fundamental betrayal of such a relationship. The professional must be sensitive to the possibility that the clinical relationship may create a vulnerability or dependency on the part of the patient/client. The patient/client, must be confident that the services provided will not involve sexual abuse. Professional Conduct Guidelines are intended to:  Identify risks and increase awareness of situations in which sexual involvement might occur  Prevent inappropriate patient/client interaction  Ensure that boundaries are established and maintained between the professional and his or her patients/clients  Establish processes for initiating, maintaining and terminating personal and professional relationships with patients/clients  Develop awareness of multicultural practice issues and issues related to patient/client age or disability

March 2013 CASLPO•OAOO PAGE 5 SEXUAL ABUSE PREVENTION PROGRAM

PROFESSIONAL EDUCATION PROGRAM

CASLPO is committed to providing ongoing education, direction and support to its Members on the topic of sexual abuse of patients/clients. The objectives of CASLPO's professional education program include:  Increasing awareness of professional development opportunities for Members on the topic of sexual abuse and its impact on patients/clients  Developing and collecting resource materials related to the topic of sexual abuse  Collaborating with business, professional, and educational partners to enhance the development and delivery of educational offerings for Members  Alerting Members to high risk situations and the consequences of engaging in sexual abuse  Providing assistance, direction and resource support to Members in matters related to the reporting or disclosure of information concerning sexual abuse of patients/clients in respect of a Member of this or another regulated health profession  Educating Members about mandatory reporting requirements  Educating Members about the complaints process and special procedures available for the reporting of complaints related to sexual abuse These objectives are met by:  Developing and distributing professional conduct guidelines  Developing and compiling resource and educational materials related to sexual abuse and its prevention  Collecting data on reports and complaints of sexual abuse  Publishing the findings of disciplinary hearings related to sexual abuse  Developing educational materials concerning circumstances arising from complaints and discipline matters and providing clear guidance on how such situations can be prevented  Complying with all terms of any evaluation of CASLPO's Patient Relations Program by the Health Professions Regulatory Advisory Council as set out in the RHPA  Collaborating with other colleges, either individually or through the Federation of Health Regulatory Colleges of Ontario (“FHRCO”) in the development and delivery of educational materials  Providing information to Members and the public on mechanisms for the reporting of sexual abuse including the complaints process and mandatory reporting requirements  Recognizing the different needs of diverse populations, (e.g., children, people of different cultural, religious, and/or language backgrounds, individuals with different communication challenges) in the design and delivery of educational programs and services relating to sexual abuse

March 2013 CASLPO•OAOO PAGE 6 SEXUAL ABUSE PREVENTION PROGRAM

STAFF EDUCATION

CASLPO recognizes that it may be difficult for CASLPO Members or members of the public to report an occurrence of sexual abuse. This difficulty may arise from the fear that the process could be painful and result in further victimization or that additional unpleasant consequences might arise from the reporting process. CASLPO is committed to ensuring that staff members are properly trained and that proper procedures exist for the intake of complaints or reports of sexual abuse. Such procedures will be implemented in a competent, caring, and sensitive manner that does not lend itself to the re-victimization of a complainant. Staff responsible for the intake of complaints receive special training in this regard.

March 2013 CASLPO•OAOO PAGE 7 SEXUAL ABUSE PREVENTION PROGRAM

PUBLIC EDUCATION

CASLPO is committed to its role of protecting the public by providing education about the role of the profession, standards of care and the College's regulatory responsibilities. Issues related to sexual abuse and reporting mechanisms are an integral part of this process. To this end CASLPO has articulated a philosophy of "zero tolerance" of sexual abuse. CASLPO strives towards further protecting the public by informing the public of the role of the College and providing supportive and accessible facilities to its Members and members of the public. Elements of a public education strategy to increase awareness of the College and its role in the prevention and elimination of sexual abuse by its Members include:  Dissemination of information on the definition of sexual abuse  Dissemination of information on reporting and complaints procedures in general, and on reporting and complaints procedures specific to sexual abuse  Provision of information and resources to Members and members of the public on access to support groups for survivors of sexual abuse and funding for therapy and counselling for persons who while patients/clients were sexually abused by Members  Collaboration with FHRCO and with individual colleges and others in activities designed to increase knowledge of the RHPA and its various provisions for preventing and dealing with sexual abuse

March 2013 CASLPO•OAOO PAGE 8 SEXUAL ABUSE PREVENTION PROGRAM

FUNDING OF THERAPY AND COUNSELLING OF VICTIMS

Under the terms of the RHPA, all regulatory health colleges are required to establish a fund to provide financing for the delivery of therapy and counselling services for members of the public who, while patients/clients, were sexually abused by Members of the College. The fund has been established and monies accrue annually to the fund to a limit of $10,000. Monies that are recovered through court action taken by the College against a Member will be returned to the fund. CASLPO's policy position on the matter of eligibility for funding for therapy and counselling is that a complainant is eligible if:  the Discipline Committee finds a Member guilty of sexual abuse  the funding that is provided to a person shall be reduced by the amount that the Ontario Health Insurance Plan or a private insurer is required to pay for therapy or counselling for the person during the period of time during which funding may be provided for him or her under the program.  subject to provisions in the RHPA, the complainant is free to choose a particular counselor or therapist, and funds are paid by the College directly to the therapist or counselor. The College is permitted to require that the therapist or counselor sign a document to ensure that minimal provisions have been met.

March 2013 CASLPO•OAOO PAGE 9 SEXUAL ABUSE PREVENTION PROGRAM

REHABILITATION OF MEMBERS

Members who apply for reinstatement after having their registration revoked as a result of sexual abuse of a patient or client after the mandatory five (5) year waiting period will have their application reviewed by the Discipline Committee prior to returning to practice. The potential of rehabilitation of the Member will be considered on an individual basis.

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PROCEDURES FOR HANDLING COMPLAINTS

CASLPO's procedures for handling complaints are specified within the RHPA and are similar to those of all other Colleges regulated under the RHPA. These procedures are described in a variety of resource materials including CASLPO's complaints brochure. Enhanced procedures which are complainant-centered and designed to provide a safe, supportive environment are applied to this process when complaints pertain to misconduct of a sexual nature. In the event of a complaint, the College will ensure the immediate availability of a staff member to process the complaint. Due to the sensitivity of sexual abuse complaints, the complainant will be advised that he or she may request to speak to a staff member of either gender. Complainants will also have the option of speaking with a staff member in either official language. Complaints may be submitted in writing or in other acceptable formats. Should the complainant wish to meet with a staff member, such a meeting will be arranged in accordance with the following criteria:  The meeting will take place in a setting which ensures the complainant’s privacy.  The complainant's consent will be obtained for the presence of any additional College personnel. Likewise, complainants may request that two (2) staff members attend the meeting.  Complainants will be advised prior to the meeting that they may be accompanied by individuals of their choosing (i.e., friends, counselors, interpreters, legal counsel).

March 2013 CASLPO•OAOO PAGE 11 SEXUAL ABUSE PREVENTION PROGRAM

MANDATORY REPORTS

Under section 85.1(1) of the Code, it is mandatory for regulated health professionals to file a report if they have "…reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or a different College has sexually abused a patient." Operators of facilities where regulated health professionals practice are also required to report sexual abuse of a patient/client. Reports must be made if the Member has reasonable grounds, obtained in the course of practising his or her profession, to believe that another Member of a College has sexually abused a patient/client. A report does not need to be made if the Member does not know the name of the alleged abuser. The report must be made, in writing, to the Registrar of the College of the Member who is the subject of the report within 30 days of learning of the alleged sexual abuse. The report must be submitted immediately if the Member has reasonable grounds to believe that the sexual abuse is on-going or if sexual abuse of other patients/clients could occur. The Member must use his or her best efforts to inform the patients/clients of the Member’s obligation to report the matter, although the name of the patient/client will not be included in the report unless the patient/client consents in writing. Failure to make a mandatory report is an offence punishable with a fine of up to $25,000.00 for a first offence and not more than $50,000.00 for a second or subsequent offence. The RHPA provides protection from civil lawsuits or other proceedings to anyone who files a report in good faith. Such reports need to be referred for action to the ICRC if they identify concerns about the conduct, competence or capacity of a Member.

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PENALTIES FOR SEXUAL ABUSE

If the Discipline Committee of the College makes a finding that a Member has committed an act of professional misconduct by sexually abusing a patient/client, there is a mandatory minimum penalty which must be imposed. The mandatory minimum penalty consists of a reprimand and, if the abuse involves certain sexual acts listed in the Code it also will involve revocation of the Member’s certificate of registration. An application for reinstatement of the Member’s certificate of registration cannot be made for 5 years. The Ontario Courts, including the Ontario Court of Appeal, have upheld the validity of the mandatory minimum penalty in sexual abuse cases.

In addition, after finding that a Member has committed an act of professional misconduct by sexually abusing a patient/client, the Discipline Committee can also order the Member to reimburse the College for any funding paid out to the patient/client for therapy and/or counselling.

March 2013 CASLPO•OAOO PAGE 13 SEXUAL ABUSE PREVENTION PROGRAM

PROGRAM EVALUATION

CASLPO will monitor the handling of sexual abuse complaints on an ongoing basis, and the Patient Relations Committee will recommend appropriate revisions to this Program.

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FOR MORE INFORMATION

Please feel free to contact the College by mail, phone, fax or e-mail if you have questions regarding this or other College publications. The College’s Director of Professional Conduct can be contacted by email at [email protected] or by phone at 416-975-5347 ext. 221, or toll free at 1-800-993- 9459 ext. 221. The College’s Registrar can be contacted by email at [email protected] or by phone at 416-975-5347 ext. 215, or toll free at 1-800-993-9459 ext. 215.

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SEXUAL ABUSE PREVENTION PROGRAM

DRAFT

5060-3080 Yonge Street Toronto, Ontario M4N 3N1 APPROVED: MARCH 2013 416-975-5347 1-800-993-9459 www.caslpo.com EFFECTIVE: REVISED – EFFECTIVE:

TABLE OF CONTENTS

EXECUTIVE SUMMARY ...... 1 INTRODUCTION ...... 1 STATEMENT OF POSITION ...... 1 GUIDING PRINCIPLES ...... 2-3 GOAL AND OBJECTIVES ...... 4 GUIDELINES FOR PROFESSIONAL CONDUCT ...... 5 PROFESSIONAL EDUCATION PROGRAM ...... 6 STAFF EDUCATION ...... 7 PUBLIC EDUCATION ...... 7 ENHANCEMENTS TO THE PUBLIC REGISTER ...... 8 FUNDING OF THERAPY AND COUNSELLING OF VICTIMS ...... 9 PROCEDURES FOR HANDING COMPLAINTS ...... 10 MANDATORY REPORTS ...... 11 ENHANCED DISCIPLINE RULES OF PROCEDURE ...... 12 PENALTIES FOR SEXUAL ABUSE: MANDATORY REVOCATION ...... 13 APPLYING FOR REINSTATEMENT ...... 14 PROGRAM EVALUATION ...... 14 APPENDIX A: EXTERNAL RESOURCES ...... 15

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EXECUTIVE SUMMARY

This Sexual Abuse Prevention Program (“Program”) was developed by the College of Audiologists and Speech-Language Pathologists of Ontario's (“CASLPO”) Patient Relations Committee. The function of the Patient Relations Committee is to enhance relations between members and patients.

The purpose of this Program is to inform audiology (“AUD”) and speech-language pathology (“SLP”) members of CASLPO and the public concerning CASLPO's measures for preventing and addressing sexual abuse.

INTRODUCTION

Under the Health Professions Procedural Code (the “Code”), being Schedule 2 of the Regulated Health Professions Act, 1991, (the “RHPA”) each regulatory health college must have a Patient Relations Committee and a Patient Relations Program.

The Patient Relations Program must include measures for preventing and dealing with sexual abuse of patients. Specifically, the program must include educational requirements for AUDs and SLPs, guidelines for the conduct of AUDs and SLPs with their patients, training for the College’s staff and the provision of information to the public. CASLPO has been diligent in its efforts to comply with these requirements.

In keeping with the requirement to deal with AUDs and SLPs who sexually abuse patients, a variety of measures have been implemented. Staff and council member training on the nature of sexual abuse is provided on an ongoing basis. Intake procedures for complaints have been enhanced to address specific complaints of a sexual nature. CASLPO maintains a fund to provide counselling for survivors of sexual abuse.

This Program is the cornerstone of the College’s strategy for preventing sexual abuse. It is intended to give AUDs and SLPs guidance respecting CASLPO's position of "zero tolerance" of sexual abuse and to provide information and direction to AUDs and SLPs concerning their obligations under provincial legislation. The Program is also intended to provide a policy foundation for the further development of information resources and procedures to support the goal of eliminating sexual abuse.

STATEMENT OF POSITION

Sexual abuse within a therapeutic relationship is unacceptable and will not be tolerated.

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GUIDING PRINCIPLES

Zero Tolerance Sexual Abuse

The term "zero tolerance" refers to the College’s For the purposes of sexual abuse, the RHPA defines position that sexual abuse of patients by AUDs or a patient as an individual who is an AUD or SLP’s SLPs will not be tolerated.1 patient and/or was an AUD or SLP’s patient within one year of the treatment relationship ending.2

Further the Code3 identifies “sexual abuse” of a patient by a member to be:

→ sexual intercourse or other forms of physical sexual relations between the member and the patient, → touching, of a sexual nature, of the patient by the member, or → behaviour or remarks of a sexual nature by the member towards the patient.

Prevention Sensitivity

CASLPO is committed to the prevention of CASLPO acknowledges the potential vulnerability of inappropriate behaviour and demonstrates this patients and provides a reporting process that is commitment by educating AUDs and SLPs through accessible and sensitive to their needs. Anyone with standards of practice, College communications, a communication and/or hearing barrier can access educational webinars, in-person presentations and CASLPO’s website to find resources in an accessible practice advice for both professions. format. (http://www.caslpo.com/accessibility/Include CASLPO also requires each new applicant to satisfy include Icon) to the Registration Committee the requirement of good character for the issuance of any certificate of registration4.

1 For further discussion, see M. McPhedran’s report “To Zero: Independent Report of the Minister’s Task Force on the Prevention of Sexual Abuse of Patients and the Regulated Health Professions Act, 1991.” December 15, 2015; released September 7, 2016. 2 Section 1(6) the Health Professions Procedural Code (the “Code”) being Schedule 2 of the Regulated Health Professions Act, 1991 (RHPA). The Minister has further powers under clause 43 (1) (o) of the RHPA; however, at the time of writing the Minister has not implemented further definitions of patient. 3 Section 1(3) of the Code. 4 This includes an evaluation of criminal offences, findings or proceedings by other regulatory bodies (inside or outside of Ontario) and circumstances concerning the loss of registration from a profession.

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The new definition of “patient” came into force on May 1, 2018.5 AUDs and SLPs should be aware that a patient’s consent to begin or continue with treatment while engaged in a sexual relationship does not eliminate the abusive nature of the conduct as defined by the RHPA. A zero-tolerance policy means that there is no acceptable explanation or excuse for engaging in a sexual relationship with a patient and that the patient’s consent is irrelevant.6

This definition also applies to spousal relationships. Providing treatment to a spouse would be considered sexual abuse under this legislative framework.7 Therefore, the treatment of spouses is prohibited.

All AUDs and SLPs are expected to behave in a professional manner, which includes (among other things) refraining from sexual abuse of their patient.8

5 The previous definition did not identify an individual as a “patient” for a full year following the end of the treatment relationship. At that time, CASLPO advised its membership that, following the end of a treatment relationship, depending upon the circumstances, it may never be acceptable to enter into a sexual relationship with a former patient. 6 Rosenberg v. College of Physicians of Ontario (2006), 275 D.L.R. (4th) 275 7 Leering v. College of Chiropractors of Ontario (2010) ONCA 87 (CanLII)

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GOALS AND OBJECTIVES

CASLPO's Sexual Abuse Prevention Program has the following goals and objectives:

1. Provide a strategic focus for the development of programs, procedures, resources and activities aimed at preventing and eliminating sexual abuse 2. Have measures and education in place for preventing sexual abuse, including: a. Position Statement on Professional Relationships and Boundaries b. Required self-assessment through the Quality Assurance Program c. Good character requirements for all new applicants to the College 3. Have measures in place for addressing instances of AUDs and SLPs sexually abusing patients, including a. Risk assessment analysis for intake of complaints and reports b. Revised Rule of Procedure for witnesses in discipline hearings

GUIDELINES FOR PROFESSIONAL CONDUCT OF AUDIOLOGISTS AND SPEECH-LANGUAGE PATHOLOGISTS

The Code specifies that measures for preventing and dealing with sexual abuse of patients must include "guidelines for the conduct of members with their patients" (paragraph b of subsection 84(3)). The following outlines CASLPO's position with respect to the nature of the professional relationship and basic parameters regarding professional conduct. For further information, refer to CASLPO’s “Position Statement on Professional Relationships and Boundaries” (available at the end of this document).

Guideline 1: The purpose of the relationship between an AUD or SLP and a patient is to provide assessment, treatment, and management of communication and hearing disorders as defined in the scope of practice and Practice Standards.

Guideline 2: It is the AUD’s and SLP’s responsibility to establish a therapeutic relationship with the patient based on trust, support and mutual respect. Sexually abusive behaviour is a fundamental betrayal of such a therapeutic relationship.

Guideline 3: The AUD or SLP must be sensitive to the inherent vulnerability created by the clinical relationship. This relationship may also result in dependency on the part of the patient.

Guideline 4: AUDs and SLPs must be cognizant of their own cultural perspectives which may impact how they engage in the therapeutic relationship with patients.

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Professional Conduct Guidelines are intended to:

• Identify risks and increase awareness of situations in which sexual involvement might occur • Prevent inappropriate patient interaction, including a spousal relationship • Ensure that boundaries are established and maintained between the professional and his or her patients • Establish processes for initiating, maintaining and terminating professional relationships with patients • Be responsive to cultural practice issues9

9 For more information, please refer to CASLPO’s “Guide for Service Delivery Across Diverse Cultures”

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PROFESSIONAL EDUCATION PROGRAM

CASLPO is committed to providing ongoing education, direction and support to AUDs and SLPs on the topic of sexual abuse of patients. The objectives of CASLPO's professional education program include:

• Increasing awareness of professional development opportunities for AUDs and SLPs on the topic of sexual abuse and its impact on patients • Developing and collecting resource materials related to the topic of sexual abuse • Collaborating with business, professional, and educational partners to enhance the development and delivery of education to AUDs and SLPs • Alerting AUDs and SLPs to high risk situations and the consequences of engaging in sexual abuse • Providing assistance, direction and resource support to AUDs and SLPs in matters related to the reporting or disclosure of information concerning sexual abuse of patients in respect of a Member of this or another regulated health profession • Educating AUDs, SLPs and employers about mandatory reporting requirements • Educating AUDs and SLPs about the complaints process and special procedures available for the reporting of complaints related to sexual abuse

These objectives are achieved by:

• Developing and compiling resource and educational materials related to sexual abuse and its prevention • Collecting data on reports and complaints of sexual abuse • Making available educational materials concerning circumstances arising from complaints and discipline matters and providing clear guidance on how such situations can be prevented • Complying with all terms of any evaluation of CASLPO's Patient Relations Program by the Health Professions Regulatory Advisory Council as set out in the RHPA • Collaborating with other colleges, either individually or through the Federation of Health Regulatory Colleges of Ontario (“FHRCO”) in the development and delivery of educational materials • Providing information to AUDs and SLPs and the public on mechanisms for the reporting of sexual abuse including the complaints process and mandatory reporting requirements • Recognizing the different needs of diverse populations, (e.g., children, people of different cultural, religious, and/or language backgrounds, individuals with different communication challenges) in the design and delivery of educational programs and services relating to sexual abuse

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STAFF EDUCATION

CASLPO recognizes that it may be difficult for members of the public or AUDs and SLPs to report an occurrence of sexual abuse. This difficulty may arise from the fear that the process could be painful and result in further victimization or that additional unpleasant consequences might arise from the reporting process.

CASLPO is committed to ensuring that staff members are properly trained and that proper procedures exist for the intake of complaints or reports of sexual abuse. Such procedures assess risk to the patient, and the public, and are implemented in a caring and sensitive manner that does not lend itself to the re-victimization of a complainant. All staff at CASLPO receive training for the intake of complaints involving sexual abuse. This education is updated on a consistent basis to provide important information on legislative changes and amendments.

PUBLIC EDUCATION

CASLPO strives to further protect the public by informing them of the role of the College and by providing supportive and accessible resources to the public, AUDs and SLPs. Elements of a public education strategy to increase awareness of the College and its role in the prevention and elimination of sexual abuse by AUDs and SLPs include:

• Publication of information on the definition of sexual abuse • Publication of information on reporting and complaints procedures in general, and on reporting and complaints procedures specific to sexual abuse • Provision of information and resources to the public and AUDs and SLPs on how to access support groups for survivors of sexual abuse and funding for therapy and counselling for patients who were sexually abused by AUDs and SLPs • Collaboration with FHRCO and with individual colleges and others in activities designed to increase knowledge of the RHPA and its various provisions for preventing and dealing with sexual abuse

Please see Appendix A for a list of community organizations which can provide support and assistance to those who have been sexually abused by health care professionals.

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ENHANCEMENTS TO THE PUBLIC REGISTER

CASLPO is committed to increasing the transparency of information available to the public about audiologists and speech-language pathologists. The public now has access to more information about their health care providers via CASLPO’s public register, which includes:

• Information respecting charges, findings of guilt and conditions of release made under the Criminal Code (Canada) and/or Controlled Drug and Substances Act (Canada) • Other information respecting charges, findings of guilt and conditions of release under a federal, provincial or other offence which the Registrar believes is relevant to the member’s suitability to practice. • Every referral to the Discipline Committee by the Inquiries, Complaints and Reports Committee • Information on interim orders • Findings of professional misconduct or incompetence made by other regulators

It is important for the public to be aware of conduct that could affect their therapeutic relationship with an AUD or SLP, even if the conduct occurred outside of Ontario. To access the public register, please see our website “Find an Audiologist and Speech-Language Pathologist” (here).

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FUNDING OF THERAPY AND COUNSELLING OF VICTIMS

CASLPO's policy position on the matter of eligibility for funding for therapy and counselling is that a patient is eligible if:

• it is alleged, in a complaint or report, that the patient was sexually abused by an AUD or SLP while receiving treatment, or within one (1) year following the termination of the treatment relationship; • the Discipline Committee finds a Member guilty of sexual abuse • the funding that is provided to a person shall be reduced by the amount that the Ontario Health Insurance Plan or a private insurer is required to pay for therapy or counselling for the person during the period of time which funding may be provided for him or her under the program. • subject to provisions in the RHPA, the patient is free to choose a particular counselor or therapist subject to the following restrictions:

1. The therapist or counsellor must not be a person to whom the eligible person has any family relationship. 2. The therapist or counsellor must not be a person who, to CASLPO’s knowledge, has at any time or in any jurisdiction been found guilty of professional misconduct of a sexual nature or been found civilly or criminally liable for an act of a similar nature. 3. If the therapist or counsellor is not a member of a regulated health profession, CASLPO may require the person to sign a document indicating that he or she understands that the therapist or counsellor is not subject to professional discipline.

Funding is available for therapy or counselling that was provided at any time after the alleged sexual abuse took place. CASLPO is committed to supporting patients who have been sexually abused by an AUD or SLP and will not require them to appear or testify in a College proceeding. Further, a person is not required to undergo a psychological or other assessment before receiving funding.

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PROCEDURES FOR HANDING COMPLAINTS

In the event of a complaint, the College will ensure the immediate availability of a staff member to process the complaint. Due to the sensitivity of sexual abuse complaints, the complainant will be advised that he or she may request to speak to a staff member of either gender. Complaints may be submitted in writing or in other acceptable recorded formats.

Should the complainant wish to meet with a staff member, such a meeting will be arranged in accordance with the following criteria:

• The meeting will take place in a setting which ensures the complainant’s privacy. • The complainant's consent will be obtained for the presence of any additional College personnel. Likewise, complainants may request that two (2) staff members attend the meeting. • Complainants will be advised prior to the meeting that they may be accompanied by individuals of their choosing (i.e., friends, counselors, interpreters, legal counsel).

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MANDATORY REPORTS

Mandatory Reports10

Under paragraph 1 of section 85.1 of the Code, it is mandatory for regulated health professionals to file a report if they have "…reasonable grounds, obtained in the course of practising the profession, to believe that another member of the same or a different College has sexually abused a patient." In the case of another health care professional sexually abusing a patient, the report should be sent directly to the regulatory College which governs that health care professional.11 Operators of facilities where regulated health professionals practice are also required to report sexual abuse of a patient.

The report must be made, in writing, to the Registrar of the College of the Member who is the subject of the report within 30 days of learning of the alleged sexual abuse. The report must be submitted immediately if the Member has reasonable grounds to believe that the sexual abuse is on-going or if sexual abuse of other patients could occur. The AUD or SLP must use his or her best efforts to inform the patients of the AUD or SLP’s obligation to report the matter, although the name of the patient will not be included in the report unless the patient consents in writing.

Failure to make a mandatory report is an offence punishable with a fine of up to $50,000.00 for an individual and up to $200,000.00 in the case of a corporation. The RHPA provides protection from civil lawsuits or other proceedings to anyone who files a report in good faith. Such reports need to be referred for action to the ICRC if they identify concerns about the conduct, competence or capacity of a Member.

10 Members should be aware of additional requirements for practitioners under the Child, Youth and Family Services Act, 2017 to report any reasonable suspicion that a child has been, or is at risk, of suffering mental, emotional or physical harm and the person having charge of the child is responsible or ought to know of the harm. This report should be made to the Children’s Aid Society. 11 Please refer to the Federation of Regulatory Health Colleges of Ontario’s website for a list of Health Colleges (here).

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ENHANCED DISCIPLINE RULES OF PROCEDURE

To enhance the protections given to vulnerable witnesses in cases of sexual abuse or professional misconduct of a sexual nature, the College’s Discipline Committee revised its Rules of Procedure to introduce added protections for vulnerable witnesses, such as survivors of sexual abuse.12 Specifically, the Rules of Procedure include:

Subrules 11.07(1) to 11.07(5) relate to orders that a panel of the Discipline Committee can make for witnesses to have support persons available during testimony, provide for the ability of witnesses to testify behind screens or devices or by close circuit television, prevent an accused AUD or SLP from cross-examining a witness directly and appointing an alternative to cross-examine a witness.

12 This change was also made in recognition of recommendations that were made in the To Zero report (see recommendation no. 7).

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PENALTIES FOR SEXUAL ABUSE: MANDATORY REVOCATION

If the Discipline Committee of the College makes a finding that an AUD or SLP has committed an act of professional misconduct by sexually abusing a patient, there is a mandatory minimum penalty which must be imposed. The mandatory minimum penalty consists of a reprimand and, if the abuse involves certain sexual acts listed in the Code and the Minister’s Regulation13, it also will involve revocation of the AUD or SLP’s certificate of registration. An application for reinstatement of the AUD or SLP’s certificate of registration cannot be made for 5 years. The Ontario Courts, including the Ontario Court of Appeal, have upheld the validity of the mandatory minimum penalty in sexual abuse cases.

In addition, after finding that an AUD or SLP has committed an act of professional misconduct by sexually abusing a patient, the Discipline Committee can also order the AUD or SLP to reimburse the College for any funding paid out to the patient for therapy and/or counselling.

APPLYING FOR REINSTATEMENT

AUDs and SLPs who apply for reinstatement after having their registration revoked as a result of sexual abuse of a patient after the mandatory five (5) year waiting period will have their application reviewed by the Discipline Committee prior to returning to practice. The potential of rehabilitation of the AUD or SLP will be considered on an individual basis. It should be noted that, regardless of reinstatement, the discipline decision will remain on the public register.

13 Ontario Regulation 262/18 – Prescribed Offences – Health Professions Procedural Code: identifies the following sections of the Criminal Code (Canada): sections 151, 152, 153, 153.1, subsection 160 (3) and sections 162, 162.1, 163.1, 170, 171.1, 172.1, 172.2, 271, 272 and 273.

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PROGRAM EVALUATION

CASLPO will monitor the handling of sexual abuse complaints on an annual basis, and the Patient Relations Committee will recommend appropriate revisions to this Program as necessary.

FOR MORE INFORMATION

Please feel free to contact the College by mail, phone, fax or e-mail if you have questions regarding this or other College publications.

A mandatory report does not need to be made if the Member does not know the name of the alleged abuser. If you are unclear about whether to make a report or how to handle suspicions of sexual abuse, please contact the College for further information.

The College’s Director of Professional Conduct & General Counsel can be contacted by email at [email protected] or by phone at 416-975-5347 ext. 221, or toll free at 1-800-993- 9459 ext. 221. The College’s Registrar can be contacted by email at [email protected] or by phone at 416- 975-5347 ext. 215, or toll free at 1-800-993-9459 ext. 215.

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APPENDIX A

External Resources

As part of CASLPO’s Sexual Abuse Prevention Program, staff compile a list of organizations in the community which can provide support and assistance to those who have been sexually abused by health care professionals. Please note that this is not a comprehensive list.

Ontario Network of Sexual Assault Care & Treatment Centres http://www.satcontario.com/en/view.php?key=39&lang=en

Ontario Coalition of Rape Crisis Centres http://www.sexualassaultsupport.ca/

Canadian Centre for Abuse Awareness https://abusehurts.ca/

Assaulted Women’s Helpline http://awhl.org

Fem’aide – Ligne de solutien pour femmes touchées par la violence http://www.femaide.ca/

Family Association of Ontario http://familyserviceontario.org

Ontario Women’s Justice Network http://owjn.org/owjn_2009/getting-support

Community Advocacy & Legal Centre Ontario (CLEO) http://www.communitylegalcentre.ca/referrals/Women.htm

Association of Native Child & Family Services Associations of Ontario http://www.chiefs-of- ontario.org/node/147

Aboriginal Health Access Centres http://aohc.org/aboriginal-health-access-centres

Native Women’s Resource Centre (GTA) http://www.nwrct.ca/get_help/index.php

Disabled Women’s Network (DAWN) of Canada http://www.dawncanada.net/

Ministry of the Attorney General – Victim Services (list of organizations providing services for victims of crime) http://www.attorneygeneral.jus.gov.on.ca/english/ovss/programs.asp

Human Rights Legal Support Centre / Centre d’assistance juridique en matière de droits de la personne de l’Ontario www.hrlsc.on.ca

Legal Aid Ontario (https://www.legalaid.on.ca/en/)

Francophone phone lines for Legal Aid Ontario (https://www.legalaid.on.ca/en/contact/flapp.asp

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Q2 - 2019 - Quarterly Business Report - Jan. 1/19 - March 31/19

Only items with activity during Q2 For the FULL Strat Plan Report 2019 will appear on worksheet go to the Box folder STRATEGIC PRIORITY 1 – Protect the public by directly On Track for Delays/changes Strategy on engaging patients completion anticipated hold/cancelled

and stakeholders to inform our work Key Outcome Activity this Quarter Status Initiatives/ Measures Strategies 1 Collaborate Regular participation Survey for the CAG prepared for with existing in the Citizens May 4 meeting targetting patient groups Advisory Group accessibility of the Public to capitalize on (CAG) Register existing resources Survey results from specific patient groups regarding: - Quality of services Ongoing - College processes - Perceptions of patient risk

4 Ensure the Information on the Resources Section revamped and website is website is user- launched Feb 13, 2019 designed to friendly and has the

directly engage capacity to do Ongoing the public, surveys patients and members

7 Align the SAT The Indicators on the QAC has approved 4 additional with risk levels SAT focus on risk to indicators for 2020 that reflect to increase the public areas of risk (high frequency of member focus member issues and/or high Ongoing on high risk potential for harm): see QAC practice report to June/19 Council

Strategic Plan - Key Initiatives, Outcome Measures and Activities

STRATEGIC PRIORITY 1 – Protect the public by directly engaging patients and

On Track for Delays/changes Strategy on stakeholders to inform our work completion anticipated hold/cancelled Key Initiatives/ Strategies Outcome Measures Activities this Quarter Status

1 Collaborate with existing patient groups to Regular participation in the Citizens Advisory Group (CAG) Survey for the CAG prepared for May 4 meeting targetting Ongoing capitalize on existing resources accessibility of the Public Register Survey results from specific patient groups regarding: - Quality of services - College processes - Perceptions of patient risk

2 Expand the work of the Patient Relations Patient Relations Committee work is expanded to incude Year 2 Committee participation in new public awareness activities

3 Increase the public’s trust in our members through Seek out opportunities to directly engage public and Participated in the Zoomer Show Toronto on Oct. 28/18. Ongoing outreach activities that emphasize members provide information about the College and what is quality 500 people from the public spoke with CASLPO staff about quality of practice practice Ontario health regulators, the website and the understanding that they have the ability to easily access trustworthy and up-to-date information about the Colleges 4 Ensure the website is designed to directly engage Information on the website is user-friendly and has the Resources Section revamped and launched Feb 13, 2019 Ongoing the public, patients and members capacity to do surveys

5 Consider employers (of our members) as a Employer channels for communication with CASLPO are Commence in Fall segment of the public that we will directly engage established 2019

Employers understand their role with regard to CASLPO members STRATEGIC PRIORITY 2 - Applying risk-based principles to regulation

Key Initiatives/Strategies Outcome Measures Activities this Quarter Status 6 Collaborate with members to identify practice Comprehensive strategies for types of complaints/ Used Canadian Audiology Association (CAA) Convention areas that pose risks Investiations (both preventative and remedial) are booth opportunity to provide face-to-face discussion and employed with: surveying. The 40 respondents identified the top 4 - Advertising complaints challenges to practice within standards: - Inappropriate 3rd party billing -Non prescribed hearing aids -Sexual assault/boundaries -3rd party funding - Clinical judgment skills -Advertising -Use of social media 7 Align the SAT with risk levels to increase member The Indicators on the SAT focus on risk to the public QAC has approved 4 additional indicators for 2020 that Ongoing focus on high risk practice reflect areas of risk (high frequency of member issues and/or high potential for harm): see QAC report to June/19 Council

8 Align mentorship with risk of harm so that Mentors are equipped with resources/tools to identify and Year 3 mentors are focused on high risk practice settings address risk behaviours/settings for further intervention with the mentee 9 Assist members in identifying their own risk levels A “Risk Tool” is available allowing members to consider Year 2 key elements and generate a personal risk level, along with strategies to mitigate risk 10 Consider peer assessment random selection Identify through research and data- mining, significant risk process in order to reflect established risk factors factors in practice

Peer assessment program reflects risk of harm STRATEGIC PRIOIRTY 3 – Harmonizing registration and practice standards across Canada

Key Initiatives//Strategies Outcome Measures Activities this Quarter Status

11 Collaborate with universities to identify mutual Establish channel for communication between CASLPO and Year 3 interests universities that allow for alignment of training with registration requirements Collaborate with CAASPR to identify CAASPR's fairness principles align with CASLPO's Year 3 harmonization opportunities requirements set by Ontario Fairness Commission (OFC)

Identify common principles of fairness across Canada (including OFC’s) to ensure the new processes meet these requirements

Create a proposal for cross-provincial telepractice

12 Ensure practitioners moving to Ontario meet the A communication product for the public that Year 3 same standards as our members communicates trust in professionals wherever they are trained and wherever they work 13 Facilitate data sharing across provinces Establish supports and processes for sharing member Year 2 and 3 conduct history

Utilize data to determine patterns of conduct issues common across Canada 14 Take the lead in communicating harmonization to A communication product that all provinces could use to Year 2 all stakeholders, including international programs communicate changes to registration 2018-19 Operational Plan CASLPO Strategic Plan Directly Engage Patients and Other Stakeholders to Inform our Work Patient Engagement Employers Engagement Establish a link with the Citizen Advisory Establish communication to determine their Group (CAG) as a new channel for needs with respect to knowledge about CASLPO’s utilizing patient engagement registration process, mentorship and their opportunities (Communications) reporting obligations (Registration and Professional Conduct)

Mentor Training Provide training to mentors on the Communicatively Accessible Resources Research and implement appropriate basics of mentorship and evaluation communicatively accessible resources to enable expectations. Feedback will be obtained the public to find an audiologist and SLP on the to provide direction for future mentor website and to understand conduct information on training initiatives (Registration) the public register (Practice Advice) Clinical Reasoning Tool in Mentorship Website Consult a focus group of mentors Explore and implement new website navigation regarding how the Clinical Reasoning and engagement mechanisms. (i.e. ‘Polling Tool (CRT) may be used in mentorship software’, and improved landing page (Registration) navigation to directly engage the public, patients and members) (Communications) Outreach Opportunities Explore new outreach activity opportunities Member Portal that emphasize the quality of practice of Survey members to obtain feedback on improving members to increase the public’s trust in our and increasing the use of the member portal members and to gather data (Communications) (Registration and IT) Apply Risk-Based Principles to our Policies and Programs

Conduct Research Evaluate Trends

Explore patient risk of harm by collecting Evaluate practice trends and areas of risk qualitative and quantitative data from 1) of harm to direct communications and external research, and 2) stakeholders. The education. data will help to identify the behavioural and (Professional Practice and Professional environmental risk factors that will be Conduct) explored internally in 2019-20. (Quality Assurance and Professional Conduct) Harmonize Registration and Practice Standards Across Canada

CASLPO’s Perspectives are Communication with Reflected International Programs Continue to ensure that CASLPO’s positions Create a mailing list of our top 20 and perspectives are reflected in the final international university program contacts outcomes of the national harmonization and send an email to inform these programs and centralization projects being of the upcoming changes to CASLPO’s undertaken by CAASPR. Registration Regulations and how these (Executive and Corporate) changes will impact their Canadian students in the future. (Registration) CASLPO Operational Success Pillars Teamwork and Collaboration Cross-Training Corporate Communication Policy The Registration Team will develop a Develop and implement a communication policy department cross-training manual in order around staff meetings and directors’ meetings. to provide some enhanced ability to The plan will outline the responsibilities of mitigate the impact on core functions from management and staff as well as the expected unexpected events. content and frequency of meetings. (Registration) (Executive and Corporate) Innovation, Credibility and Continuous Improvement Clinical Reasoning Education Tool System Security Improvements Create a tool for members Implement system security Peer Assessment Digitization who demonstrate insufficient improvements through new Increase the efficiency and reliability of clinical reasoning in the peer security policies, security tracking the peer assessment process Remediation Framework assessment process. audit and training by transferring it to the database. Develop a peer assessor site (Quality Assurance) (Information Technology) (Information Technology and Quality remediation framework Assurance) (Quality Assurance) Online Corporate Renewal Remediation Program Improve the efficiency and Develop a clinical reasoning ease of Corporation renewals tool remediation program to (Information Technology) be incorporated in the new peer assessors training Succession Planning program. Develop methods to attract more (Quality Assurance) members from diverse backgrounds to participate in College processes and projects, in order to increase Enhanced Professional Development the diversity of input to College Invest in our people by creating work professional development (Executive and Corporate) opportunities to ensure ongoing Upgrade SQL Server Software development of skills, competencies Conduct CMP Phase 2 and expertise Increase the functionality To mitigate the risk of data (Executive and Corporate) available in the database loss and add new CMP for Conduct functionality (Information Technology) (Information Technology) Public and Stakeholder Engagement

40 60

25th Anniversary Activities 30 70 Translation of Complaint Information CASLPO will mark appropriately If supported by research, translate the th recognition of its 25 anniversary 20 80 College’s complaint information into the as a regulatory college most frequently spoken mother tongue (Executive and Corporate) languages in Ontario (based upon census data) and posted on CASLPO’s website 10 90 (Professional Conduct)

0 100 FINANCIAL REPORT FISCAL YEAR OCTOBER 1, 2018 - SEPTEMBER 30, 2019 Budget For the 6 Months Ending March 31, 2019 2017-2018 2018-2019 Actual Budget Variance 1.

Total Revenue 3,104,250 3,223,300 1,620,084 1,598,389 21,695

Expenditures Salaries and Benefits 1,532,800 1,736,200 833,955 835,660 1,704 Office and General 424,450 469,300 210,919 203,540 (7, 379) Council & Committees 181,000 192,000 59,241 70,430 11,189 Quality Assurance 106,300 99,100 42,056 48,269 6,213 Registration 47,300 31,100 653 596 (57) Professional Fees and Consultants 220,500 178,600 135,271 92,515 (42,756) Member Education and Publications 26,600 30,000 15,697 16,390 693 Investigations and Hearings 413,100 251,900 91,672 95,942 4,270 Public Awareness 61,100 114,200 17,139 16,843 (296) Depreciation and Amortization 26,100 20,900 13,880 10,450 (3, 430)

Total Expenditures 3,039,250 3,123,300 1,420,483 1,390,635 (29,848)

Net Operating Profit 65,000 100,000 199,601 207,754 (8,153)

NOTES: 1. For Variances above, a negative variance (xx,xxx) indicates an unfavourable variance from budget; a positive variance indicates a favourable variance from budget. BIG PICTURE SUMMARY

REVENUE $ 1,620,084 $ 21,695 HIGHER than budget (we generated more revenue than expected) Revenue is at 101% of budget.

EXPENSES $ 1,420,483 $ (29,848) HIGHER than budget (we spent more than budgeted) Overall, total expenses are 2% higher than budget. The main driver of the variance is related to the legal work required for CAASPR. Legal expenses have exceeded planned amounts due to the unforseen work required to determine the ramifications of conflicts arising among the provinces within CAASPR which are creating barriers to harmonization.

Please see the CASLPO Operations - Details for detailed variances and explanations of all financial statement line items.

NET OPERATING PROFIT $ 199,601 $ (8,153) LOWER than budget (we generated less profit than expected) Net Operating Profit is at 96% of budget. CASLPO Operations - Details Footnote explanations of significant variances, to March 31, 2019: Variances - Budget Budget Budget Actual (over) / under 2017/2018 2018/2019 To Mar 2019 to Mar 2019 Budget Revenue Membership fees 2,956,700 3,098,600 1,543,103 1,551, 620 8,517 1 1 Fewer resignations and status changes to non-practising than expected Registration fees 38,000 11,000 3,740 4,750 1,010 Application fees 34,050 37,500 9,750 12,300 2,550 Other fees 21,500 11,200 9,296 13,575 4,279 2 2 Generated more late fees than expected Investment income 54,000 65,000 32,500 37,840 5,340 3 3 Older investments that are coming to maturity and being reinvested at higher interest rates Total Revenue 3,104,250 3,223,300 1,598,389 1,620,084 21,695

Expenditures

Salaries and Benefits Salaries 1,272,900 1,413,100 680,408 683,578 (3,170) Employment insurance 19,500 21,000 11,340 11,231 109 Canada Pension Plan 38,000 55,800 29,574 24,471 5,103 Employee benefits 184,400 220,300 101,338 98,308 3,030 4 4 The increase in the benefit plan premiums at renewal were lower than expected Temporary help 5,000 5,000 2,500 5,511 (3,011) Learning and development 13,000 21,000 10,500 10,857 (357) 1,532,800 1,736,200 835,660 833,955 1,704

Office and General Photocopier and fax 9,700 8,700 4,350 4,167 183 Courier 1,000 1,000 500 304 196 Telephone and teleconference 13,900 14,800 7,400 6,578 822 Insurance 8,200 8,200 4,100 5,049 (949) Membership dues 38,700 39,000 27,690 30,732 (3,042) Office and sundry expenses 22,400 35,100 17,550 19,865 (2,315) Repairs and maintenance 400 400 200 435 (235) Credit card fees and bank charges 80,200 83,400 10,008 9,232 776 Internet services 2,500 2,500 1,250 1,370 (120) Rent and operating costs 206,400 228,200 104,972 100,966 4,006 5 5 2017 CAM and Realty tax refund received Travel 15,700 15,200 9,120 12,549 (3,429) CAASPR 7,350 4,500 2,250 3,315 (1,065) Payroll services 3,000 3,300 1,650 1,781 (131) Presentations 15,000 25,000 12,500 14,575 (2, 075) 424,450 469,300 203,540 210,919 (7,379)

Council & Committees Professional members - Honoraria 97,000 94,000 38,540 30,025 8,515 6 6 Budgeted discipline hearing will likely not occur in fiscal 2018-19. Professional members - Expenses 69,000 73,000 31,390 29,177 2,213 6 Council learning & development 15,000 25,000 500 38 462 181,000 192,000 70,430 59,241 11,189

Aud. & SLP Practice Committees Practice Standards & Guidelines 4,000 - - - - Quality Assurance Peer assessment expenses 74,000 78,100 38,269 33,896 4,373 Self assessment expenses 17,300 16,000 8,000 6,305 1,695 CASLPO Forums 4,000 4,000 2,000 1,856 144 Jurisprudence 7,000 1,000 - - - 106,300 99,100 48,269 42,056 6,213

Registration Mentorship program 46,000 29,800 596 653 (57) Accreditation of university programs 1,300 1,300 - - - 47,300 31,100 596 653 (57)

Professional Fees and Consultants Legal 65,000 77,000 50,050 92,490 (42,440) 7 7 Legal work related to CAASPR projects is exceeding planned amounts due to the legal advice obtained to Information technology 38,500 41,100 16,440 13,967 2,473 determine the ramifications of conflict arising among the provinces within CAASPR which are creating barriers Other consultants 85,500 31,500 11,025 9,893 1,132 to harmonization. Audit 31,000 28,000 14,000 11,118 2,882 Translation 500 1,000 1,000 7,803 (6, 803) 8 8 More than expected translation services needed for the integrated standards and guidelines project and 220,500 178,600 92,515 135,271 (42,756) enhancements to the peer assessment process

Member Education and Publications Website maintenance 3,000 3,500 1,750 2,859 (1,109) Outgoing communication 11,100 11,000 5,500 4,039 1,461 Publications 9,000 12,000 5,640 5,549 91 Elections 3,500 3,500 3,500 3,250 250 26,600 30,000 16,390 15,697 693

Discipline Hearings Legal 342,000 157,800 64,698 62,795 1,903 Complaint Investigations Investigators 53,600 76,300 28,994 26,960 2,034 Hearing expenses 13,000 13,300 - - - SCERPS 4,500 4,500 2,250 1,918 332 413,100 251,900 95,942 91,672 4,270

Public Awareness Research - 38,300 - - - Production 14,800 8,500 2,125 2,599 (474) Distribution 46,300 47,400 3,318 3,212 106 25th Anniversary 20,000 11,400 11,328 72 61,100 114,200 16,843 17,139 (296)

Amortization and Depreciation 26,100 20,900 10,450 13,880 (3, 430)

Total Expenditures 3,039,250 3,123,300 1,390,635 1,420,483 (29,848)

Net Operating Profit (Deficit) 65,000 100,000 207,754 199,601 (8, 153) MEMORANDUM

AUDITOR ASSESSMENT TOOL TO Council FROM Ruth Cimerman, Director of Finance and Operations

DATE May 30, 2019 MEETING DATE June 6, 2019

ACTIONS REQUESTED

1. Approve a pilot of the Annual Assessment component of the Auditor Assessment Tool for 2019. 2. Reappoint Hilborn as CASLPO’s auditor for fiscal 2019.

BACKGROUND

CASLPO’s process for recommending the reappointment of auditors is not formalized and is completed annually based on feedback from management and the Finance Committee. At the January 9, 2019 Finance Committee meeting, staff brought forward the idea of creating a more formalized and robust evaluation tool for the Committee to use during the reappointment process. Staff shared that other Colleges have already created tools for their use and could provide guidance. The Assessment Tool being put forward for your consideration is based on tools and templates provided by the Chartered Professional Accountants of Canada (CPA) and feedback from other Colleges regarding their practical use. At the May 14, 2019 Finance Committee meeting, a motion was passed to recommend that Council pilot the assessment tool for the 2018-19 audit process. The Committee will provide a report to Council using the results of the assessment tool for the next fiscal year. The report will support the recommendations that Finance Committee will make to Council regarding reappointment of the auditors.

RECOMMENDATIONS

Staff is recommending that Council approve a pilot of the Annual Assessment component of the proposed Auditor Assessment Tool prior to recommending the approval of the process to Council. In order to carry out the pilot in the suggested timelines of the Tool, Finance Committee recommends that Council reappoint Hilborn as the auditor for fiscal 2019.

CASLPO●OAOO Page 1 of 1

Annual & Comprehensive Assessment of the External Auditor by the Finance Committee1

Document Approved by Finance Committee: ______

1 The tools and templates provided by the Chartered Professional Accountants of Canada (CPA) to businesses looking to conduct both annual and comprehensive audits were used as the base to create this tool. Table of Contents

INTRODUCTION 3

TIMELINES 3 ANNUAL SCHEDULE 3

ASSESSMENT GOALS 4

ASSESSMENT ELEMENTS 5

ANNUAL ASSESSMENT PROCESS 5 1. DETERMINE THE SCOPE, TIMING AND PROCESS 5 2. OBTAIN INPUT FROM COLLEGE PERSONNEL 6 3. FINANCE COMMITTEE ANALYSIS 9 4. CONCLUDE THE ANNUAL ASSESSMENT AND COMMUNICATE RESULTS 11

COMPREHENSIVE ASSESSMENT PROCESS 13 1. ADDITIONAL INFORMATION TO DETERMINE SCOPE, TIMING, AND PROCESS 13 2. OBTAIN ADDITIONAL INFORMATION FROM STAFF 13 3. OBTAIN INPUT FROM THE AUDITOR 14 4. ADDITIONAL FINANCE COMMITTEE ANALYSIS 16 A. SAFEGUARDS AGAINST INSTITUTIONAL INDEPENDENCE AND FAMILIARITY THREATS 16 B. AUDITOR RESPONSIVENESS TO CPAB REPORTS 16 5. ADDITIONAL INFORMATION TO CONCLUDE THE COMPREHENSIVE ASSESSMENT AND COMMUNICATE RESULTS 17

APPENDIX 1 - TEMPLATES 18 TEMPLATE: ANNUAL ASSESSMENT REPORT TO COUNCIL 18 TEMPLATE: COMPREHENSIVE ASSESSMENT REPORT TO COUNCIL 19

Introduction

The Finance Committee of the College of Audiologists and Speech-Language Pathologists of Ontario (CASLPO) conducts both an Annual Assessment of the external auditor prior to reappointment, and a Comprehensive Audit Assessment in place of an Annual Assessment every five years (at minimum).2 Assessments are conducted to align with best practices as laid out under the Enhanced Audit Quality Initiative put forward by the Chartered Professional Accountants of Canada (CPA). This process allows the Committee to produce quality improvement recommendations for the external auditor annually, recommend the auditor for tender or reappointment periodically, as well as note any concerns.

It should be noted that the Annual Assessment’s purpose is to help the Committee identify areas for improvement for the audit firm, and not to decide if the auditor should be put forward for reappointment or tender. In the event that the Committee finds real concerns, they could choose to recommend tender early, but normally this would be a decision made at the time of the Comprehensive Assessment.

Following the Comprehensive Assessment the Finance Committee will either reassure Council of the quality and objectivity of the incumbent auditor and put that firm forward for re-appointment, or offer Council the recommendation that they should procure a new external auditor.

Timelines

The annual audit takes place in October each year. The financial statements are presented for approval to the Council at their December meeting. After presentation of the statements the Finance Committee is in a position to reflect on the audit process and decide on its quality and objectivity. The Finance Committee should begin either the annual or Comprehensive Assessment process at their January Finance Committee meeting with the goal of sharing with Council their recommendation at Council’s June meeting. In the event that it is not recommended that the auditor be reappointed, this allows enough time for a procurement process to be undertaken to secure a new auditor in advance of the annual audit in October.

Annual Schedule TIME DELIVERABLE

October Finance At this meeting the Finance Committee will review the previous year’s Committee Meeting assessment and decide if any changes / altered focus is required in the current year’s assessment. The Committee will determine if they will require any additional meetings with the auditor outside of the November Finance Committee Meeting, and will determine if the Committee Chair should be present for any part of the audit. Staff

2 It should be noted that the Comprehensive Assessment could be conducted earlier than every five years if the Finance Committee determines it is necessary to do a more fulsome assessment. Reasons might include a major change in corporate structure or a poor auditor assessment in the previous year. 3

will be directed to set meetings and create schedules as required.

March Finance Committee The formal assessment begins. The Finance Committee will Meeting determine if meetings with either the auditor or staff are required and will request those meetings. If not, then they will distribute surveys and set deadlines for the feedback.

May Finance Committee The Committee will review all materials and create a report for Meeting Council. They will also determine their recommendation to Council on the upcoming years assessment (will it be the standard Annual Assessment or the Comprehensive Assessment). If recommendations are being made to the auditor or staff they will need to be delivered to the appropriate party after the meeting.

June Council Meeting Finance Committee presents their summary report and (in the event of a comprehensive audit) their recommendation. They will also inform Council of the recommended assessment structure for the following year (annual or Comprehensive Assessment). Council approves the recommended assessment choice for the following year, and either reappoints the auditor or decides to go to tender to find a new auditor.

ADDITIONAL NOTES REGARDING THE SCHEDULE: • The Finance Committee may require additional meetings to complete the work, these can be in addition to the schedule above. • The Committee Chair plays a key role in assisting the Committee in following an appropriate process for the Annual Assessment. The Chair may opt to visit the College during the audit process or ask questions in advance of the initial Committee meeting so that they could guide the Committee on any changes in process or scope needed for the assessment. • To ensure that all views are considered the Committee may wish to finalize their assessment during group discussions (as opposed to collecting comments separately) during a formal Committee meeting.

Assessment Goals As stated by the CPA tools for external auditor assessment, the assessment tools should assess three key factors3:

1. Independence, objectivity and professional skepticism – Do the auditors approach their work with objectivity to ensure they appropriately question and challenge management’s assertions in preparing the financial statements?

3 These details were taken directly (with one or two small language changes) from the “Annual Assessment of the External Auditor Tool (Jan 2014) available on the website of the Chartered Professional Accounts of Canada (CPA). 4

2. Quality of the audit team – Does the audit firm put forward team members with the appropriate industry and technical skills to carry out an effective audit? 3. Quality of communications and interactions with the external auditor – Are the communications with the external auditor (written and oral) clear? Is the auditor open and frank, particularly in areas of significant judgments and estimates or when initial views differ from management?

Assessment Elements The Annual Assessment will consist of the following elements:

1) Survey(s) distributed to the Director of Finance and Operations and/or Registrar 2) Finance Committee Analysis 3) Observation of the Auditor’s performance during Finance Committee and Council meetings. There is the option to observe part of the audit itself, and the Finance Committee would decide if this was necessary at the October Committee meeting. 4) Discussions with the auditor (as required) 5) Any other elements/processes that the Finance Committee deems necessary 6) Recommendation report prepared for Council (staff support will be provided for this) 7) Report to Council

The Comprehensive Assessment will consist of the following elements:

1) Survey(s) distributed to the Director of Finance and Operations and/or Registrar 2) Finance Committee Analysis 3) Observation of the Auditor’s performance during Finance Committee and Council meetings. There is the option to observe part of the audit itself, and the Finance Committee would decide if this was necessary at the October Committee meeting. 4) Discussions with the Auditor (as required) and Auditor Feedback Survey 5) Any other elements/processes that the Finance Committee deems necessary 6) Recommendation report prepared for Council (staff support will be provided for this) 7) Council reappoints the auditor or goes to tender

Annual Assessment Process

1. Determine the scope, timing and process

Before proceeding with the Annual Assessment, the Finance Committee should review the process to ensure that no alterations are required for the current year’s audit. If changes are required to the Annual Assessment they should be made before the assessment is undertaken. Changes can be suggested at the October Committee meeting after the document review, and staff can be engaged to make the required changes and send the revised document to the Committee members.

Guiding questions:

POINTS TO CONSIDER OBSERVATION

Have there been significant changes in the organization that require changes to the assessment process this year?4

Do the results of the prior-year’s assessment indicate areas that should be given particular focus this year?

What additional information from the College is needed to help the Finance Committee conduct the assessment?

What information, if any, from the auditor is needed to help the Finance Committee conduct the assessment (e.g., future changes to the audit team)?

What changes need to be made to other sections of this tool to reflect the approach to this year’s Annual Assessment?

These determinations are key drivers for conducting an assessment process.

2. Obtain Input from College Personnel

This section of the tool includes a number of questions the Finance Committee may want to ask College personnel, such as the Registrar and the Director of Finance and Operations. The Finance Committee needs to determine whether they wish to obtain input in writing or through discussions.

QUESTIONS FOR COLLEGE PERSONNEL (Normally the Registrar and/or Director of Finance and Operations)

POINTS TO CONSIDER OBSERVATION

RE: INDEPENDENCE, OBJECTIVITY & PROFESSIONAL SKEPTICISM

4 Note that it may be appropriate to conduct a Comprehensive Assessment rather than an Annual Assessment of the external auditor, for example, if significant issues have already been identified, or if another triggering event has occurred, such as a change in the College’s corporate structure that could affect financial oversight (e.g. the Director of Finance and Operations leaves and a new system is put in place, or the Registrar leaves etc.). 6

How does the external auditor demonstrate integrity, objectivity and professional skepticism, (e.g. by maintaining a respectful but questioning approach throughout the audit)?

How does the external auditor demonstrate independence (e.g. by proactively discussing independence matters and reporting exceptions to its compliance with independence requirements)?

How were significant differences in views, if any, between management and the external auditor resolved?

How did the external auditor adjust the audit plan to respond to changing risks and circumstances?

How forthright is the external auditor in dealing with difficult situations (e.g. by proactively identifying, communicating and resolving technical issues)?

To what extent do you have concerns about the relationship between the external auditor and College personnel that might affect the external auditor’s independence, objectivity or professional skepticism?

The auditor and the audit team should have performed risk assessment at the outset of the audit including assessment of fraud risk. Conclude if this process was followed.

RE: QUALITY OF AUDITOR AND HIS/HER STAFF

How would you assess the technical competence and ability of the external auditor to translate knowledge into practice (e.g. by using technical knowledge and independent judgment to provide realistic analysis of issues and by providing appropriate levels of competence across the team)?

How would you assess the external auditor’s understanding of our business and industry (e.g. by demonstrating an understanding of our specific business risks, processes, systems and operations)?

How sufficient are resources assigned by the external auditor to complete work in a timely manner (e.g. by providing access to specialized expertise during the audit and assigning additional resources to the audit as necessary to complete work in a timely manner)?

RE: COMMUNICATION AND INTERACTION WITH THE EXTERNAL AUDITOR

How candid and complete was the dialogue between the auditor and management? How well did the auditor explain accounting and auditing issues?

How effectively does the auditor provide timely and informative communications about accounting and other relevant developments?

How does the external auditor communicate about matters affecting the College or its reputation?

Provide your overall views on how your relationship with the external auditor contributed to your ability to produce reliable financial reporting throughout the assessment period.

RE: QUALITY OF SERVICE CONSIDERATIONS

To what extent is the external auditor effective in completing the audit on a timely basis?

To what extent does the external auditor keep management informed about the progress of the audit and difficulties encountered?

To what extent has the Auditor and his/her team maintained a respectful and professional attitude during the audit?

To what extent is the external auditor proactive in identifying information requirements and timely in requesting information from management?

OTHER INPUT REQUESTED FROM STAFF

3. Finance Committee Analysis

This section should be completed by the Finance Committee, either individually, or as a group. The meeting with the auditor at the October and November Committee meetings will help inform this section of the document.

POINTS TO CONSIDER OBSERVATION

RE: INDEPENDENCE, OBJECTIVITY & PROFESSIONAL SKEPTICISM

Does the external auditor either confirm their independence or inform the Finance Committee about matters that might reasonably be thought to compromise their independence?

How did the external auditor adjust the audit plan to respond to changing risks and circumstances?

What steps does the auditor take to ensure that their staff exhibits the values, ethics and attitudes necessary to support a quality audit?

If Finance Committee is aware of any significant differences in views between management and the external auditor resolved?

What evidence is there that the audit team challenges decisions made by management in preparing the financial statements?

How would you assess the quality of the significant professional judgments made by the auditor?

RE: COMMUNICATION AND INTERACTION WITH THE EXTERNAL AUDITOR

How candid and complete was the dialogue between the auditor, the Finance Committee and/or the Finance Committee chair? How well did the auditor explain accounting and auditing issues?

How would you assess the external auditor’s discussion about the quality of the College’s financial reporting, including the reasonableness of accounting estimates and judgments, appropriateness of the accounting policies and adequacy of the disclosures?

What is your assessment of how the external auditor discussed sensitive issues (e.g. were concerns about management’s reporting processes, internal control over financial reporting or the quality of the College’s financial management team discussed in a timely, candid and professional manner)?

How promptly did the auditor alert the Finance Committee if they did not receive sufficient cooperation from staff?

How well did the external auditor inform the Finance Committee of current developments in accounting and auditing standards relevant to the College’s financial statements and their potential impact on the audit?

How does the audit firm provide continuity of team members and perform an orderly transition when key members of the team change?

RE: QUALITY OF SERVICE CONSIDERATIONS

During the audit, how well did the external auditor meet the agreed-upon performance criteria (e.g. by meeting agreed-upon performance delivery, being available and accessible to management and the Finance Committee?)

How did the auditor and audit team ensure that the necessary knowledge and skills (College- specific, industry, accounting, auditing) were dedicated to the audit?

How would you assess the professionalism of the auditor?

How proactive is the external auditor in identifying opportunities and risks, (e.g by anticipating and providing insights and approaches for potential business issues and improving internal controls)?

How would you assess the value for money delivered by the external audit (e.g. do the audit fees fairly reflect the cost of the services provided given the size, complexity and risks of the College and a cost-effective quality audit)?

OTHER INPUT REQUESTED FROM THE FINANCE COMMITTEE

4. Conclude the Annual Assessment and Communicate Results

Conclude on the results of the Annual Assessment and prepare a summary report for Council. The summary report should include a recommendation on whether the next year’s assessment should be an Annual or Comprehensive Assessment.

Points to consider:

• Has sufficient information been obtained to allow the Finance Committee to reach a conclusion and consider the assessment complete? If the preliminary results of the assessment are not satisfactory, the Committee may need to perform further due diligence to determine whether it’s preliminary conclusions are justified and to consult with those affected by its recommendations. 1. What recommendations for action should be made to the Council? These would include: • Recommendation for the following year’s audit assessment type (annual or comprehensive) • Recommendation to reappoint the auditor or go to tender (in year’s where a Comprehensive Assessment took place) • Any recommended changes to assessment procedures (as needed) 2. Does the Committee need to formally discuss the results of the assessment with the Council or will a written report suffice?

Record items to be raised with the auditor for follow-up or future changes: ITEM PERSON RESPONSIBLE FOR FOLLOW-UP

Potential future changes to the Annual Assessment, Comprehensive Assessment, or Finance Committee Process: POTENTIAL CHANGE PERSON RESPONSIBLE FOR FOLLOW-UP

The Executive team needs to be sure they share necessary feedback with the necessary parties. As a rule the Chair of the Committee will lead on this dissemination of information.

The Committee may opt to meet with staff and the audit firm jointly to discuss actions that the audit firm and management need to take jointly to address Committee concerns and any inconsistencies between input obtained from the audit firm and the staff.

Comprehensive Assessment Process

The Comprehensive Assessment assumes that the Committee has conducted robust Annual Assessments of the external auditor in the previous years. The Comprehensive Assessment includes all processes included in the Annual Assessment as well as the additional assessment elements discussed in these pages. This assessment would cover not just the previous year’s audit but would also review all audits that underwent annual assessments since the last comprehensive assessment.

It should be noted that the Finance Committee is responsible for determining the scope, timing and process for the Comprehensive Assessment and not staff or the auditor. Although the staff and the auditor contribute, the process belongs to the Finance Committee. A Comprehensive Assessment should be conducted at least every five years.

As part of the Comprehensive Assessment process the Finance Committee should look for the external auditor to identify any threats to independence and describe safeguards they have put in place. Some factors to consider would be:

(a) Number of years the audit firm has served as external auditor (b) Length of service of key audit team members (e.g. Blair MacKenzie and Peter Pang from Hilborn) (c) Whether familiarity threats have been identified and if so what safeguards have been put in place (d) The transparency of audit firm and staff interactions and whether the Executive Committee is aware of any interactions that might impair independence. (e) Whether the fees are sufficient to provide for an audit of appropriate quality taking into account changes in the College’s business.

1. Additional Information to Determine Scope, Timing, and Process

In addition to the considerations noted in the Annual Assessment process, the Finance Committee may wish to also consider the following:

POINTS TO CONSIDER OBSERVATION

When was the last Comprehensive Assessment conducted and what period should this assessment cover?5

2. Obtain Additional Information from Staff

In advance of the discussion, the Finance Committee will need to request to have the following information made available to them by staff:

5 The Comprehensive Assessment should, as a rule, cover all assessments since the previous Comprehensive Assessment. 13

 Relevant Finance Committee meeting minutes and results of Annual Assessments.  Any reports that may have relevance to the relationship with the audit firm.  Information about any significant financial reporting matters that have been questioned by regulators or the press that may have relevance for the relationship with the auditor.  A summary of relevant information from the Canadian Public Accountability Board’s (CPAB) most recent annual public report and periodic newsletters.6

3. Obtain Input from the Auditor

This section of the tool sets out the information that the Finance Committee may wish to obtain from the auditor.

In advance of the discussion, the Finance Committee can request to have the following information made available to them by the auditor:

 Analysis of total services provided by the audit firm, covering audit and non-audit services and related fees, since the last Comprehensive Assessment; explanations for differences between actual and estimated fees and between actual audit fees and cost recoveries. Consider obtaining an analysis of other auditors’ fees for similar services to comparable entities, where available.  Summary of auditor’s reports (e.g. reports to regulators, special reports).  Summary of reports issued to the Finance Committee, including significant matters addressed.  A communication from the firm regarding any conflict of interest issues, or independence

issues.7  Summary of reports to management.  Summary of key elements of the firm’s quality control processes and how they were applied to the College’s audit.

 Transparency reports8 of the audit firm (if reports are produced).  Annual reports of the audit firm (to confirm the best practices and liquidity of the firm).

6 CPAB releases periodic reports that offer guidance and recommendations to audit firms to ensure auditors remain accountable, and independent. Audit firms should be abreast of these reports and recommendations and be ensuring they are implementing any new recommended safeguards or quality assurance advice.

7 Canadian auditing standards require the auditor to communicate with the Committee all relationships between the College and the firm that, in the auditor’s professional judgment, may reasonably be thought to bear on independence. This includes total fees charged during the period covered by the financial statements for audit and non-audit services and the related safeguards that have been applied to eliminate identified threats to independence or reduce them to an acceptable level.

8 As a result of legal and regulatory requirements, audit firms in certain jurisdictions now issue transparency reports on their governance. Audit firms in other jurisdictions issue such reports voluntarily to demonstrate their commitment to audit quality. Such reports can provide useful information about an audit firm’s culture of integrity, professional excellence, accountability and continuous improvement.

POINTS TO CONSIDER OBSERVATION

How long has the audit firm been the external auditor? What steps have been taken to address possible institutional familiarity threats?

What are the firm’s plans for the training and development of the audit team?

What are the firm’s expectations as to future partner rotation or other changes to senior audit team personnel?

How are the size, and resources of the audit firm changing?

What efforts are being made to enhance audit quality within the audit firm generally and the external audit of the College specifically?

How has the audit firm’s relevant expertise in the industries and markets in which the College operates been evolving? What are the audit firm’s future plans to serve the College with an audit team with appropriate expertise?

How has the audit firm considered systemic audit quality issues identified by CPAB in its public reports?

What reputational challenges, if any, are facing the audit firm and how are these being addressed?

How have significant differences in views, if any, between CASLPO management and the firm been addressed?

OTHER INPUT REQUESTED FROM THE AUDIT FIRM

4. Additional Finance Committee Analysis

This section is supplemental to the analysis completed in the Annual Assessment process. The Committee should complete that analysis and, during a Comprehensive Assessment, this additional analysis would be conducted. Again, this section should be completed by the Finance Committee, either individually, or as a group. The meeting with the auditor at the October and November Committee meeting will help inform this section of the document.

A. Safeguards Against Institutional Independence and Familiarity Threats

POINTS TO CONSIDER OBSERVATION

What institutional familiarity threats has the audit firm identified? What steps have been taken to address them?

To what extent has the College employed former audit firm staff in key financial positions?

What personnel changes, if any, in the audit firm or the College could create a perception that the external auditor is no longer independent?

What corporate hospitality has been provided to the audit firm/management by management/the audit firm that could bring the external auditor’s independence into question?

What reputational damage or regulatory action, if any, has the audit firm suffered that could bring into question its professionalism, independence or financial stability?

B. Auditor Responsiveness to CPAB reports

In this area the Finance Committee may wish to include any specific concerns raised from their review of the summary of CPAB reports provided by staff. They can, using this area, ask about the auditor’s response to specific recommendations made by CPAB. The Committee can discuss any relevant materials with the auditor to understand how the auditor has mitigated risks pointed to in the report, and has followed recommendations. Blank boxes have been left for this purpose.

POINTS TO CONSIDER OBSERVATION

How has the audit firm responded to audit quality issues raised by the CPAB’s public reports?

If CPAB has inspected the audit file related to the College during the assessment period and made significant inspection findings, what was the cause of those findings and how has the audit firm responded?

OTHER INPUT REQUESTED FROM THE FINANCE COMMITTEE

5. Additional Information to Conclude the Comprehensive Assessment and Communicate Results

In addition to submitting a report to Council, the Finance Committee must also decide if they will recommend the current auditor for reappointment or if they will recommend the College go to tender to procure a new audit firm.

APPENDIX 1 - Templates

TEMPLATE: ANNUAL ASSESSMENT REPORT TO COUNCIL Reporting Year:

Summary Observations:

Recommendations made to the Auditor:

Recommended Audit  Comprehensive Assessment Structure for the Following  Annual Assessment Year (FOR APPROVAL BY COUNCIL):

Any recommended changes to the Assessment Process for future:

TEMPLATE: COMPREHENSIVE ASSESSMENT REPORT TO COUNCIL

Reporting Year:

Summary Observations:

Recommendation to Council – renew auditor or go to tender (FOR APPROVAL BY COUNCIL):

Recommended Audit  Comprehensive Assessment Structure for the Following  Annual Assessment Year (FOR APPROVAL BY COUNCIL):

Any recommended changes to the Assessment Process for future:

Recommendations made to the Auditor:

(In the event that the auditor is to be renewed)

MEMORANDUM

CITIZEN ADVISORY GROUP MEETING

TO Council FROM Alex Carling, Director of Professional Practice and Quality Assurance Lisa Gibson, Communications Manager DATE May 15th 2019 MEETING DATE June 6th 2019

FOR INFORMATION PURPOSES

BACKGROUND

Regulated Health Professions Act, 1991, Schedule 2, Health Professions Procedural Code Register 23 (1) The Registrar shall maintain a register. 2007, c. 10, Sched. M, s. 28.

The Practice Advice department frequently receives calls and emails from the public about accessing and understanding content on the Public Register. Because the College serves a unique population, those with communication barriers, the department developed the following operational objective: By September 30th, 2019, we will have researched the most appropriate communicatively accessible resources to enable the public to find an audiologist or SLP and to understand conduct information on the public register. The research populations will comprise the CAG and a patient/family group recruited through SLPs and AUDs. The results will inform changes made to the public register. The first part of the project was to elicit feedback from the Citizen Advisory Group (CAG). The CAG comprises members of the public who responded to recruitment advertisements. The meetings are facilitated by an external company. The department worked with Lisa Gibson, Communications Manager, to develop pre-reading material, tasks and a survey (via Survey Monkey) for the Group. Tasks were completed before the CAG meeting, and included: finding specific speech-language pathologists, establishing if they were eligible to provide services in Ontario, finding an audiologist who treats children, and finding and understanding complaint information about a specific member.

RESULTS

The CAG met on Saturday May 4th, 2019 at the College of Physiotherapists of Ontario. Lisa Gibson and Sarah Chapman-Jay, Advisor Professional Practice and Quality Assurance attended the meeting.

CASLPO●OAOO Page 1 of 3 Twelve members of the CAG participated (8 women and 4 men) guided by an external facilitator. Key discussion questions following the tasks were: 1) How easy was it to find a speech-language pathologist or audiologist? 2) Did you understand the information on the public register? 3) How can the search and navigation be improved? 4) How can the information be improved? After some discussion by the CAG, broader questions were posed by the facilitator: Question: “Taking a step back, what is the usefulness of this tool and when would you use it?” Answers: • “To find an audiologist in my neighborhood” • “If I knew it existed, I’d use it” • “If my friend recommended someone, or even if my doctor. referred, I’d check the register to protect myself”

Question: “What do you think could be changed? (I want this to be open ended); Either in the search, or to make the tool easier to use. What are the biggest changes needed?” Facilitator Instruction: “Rank Ideas; top 3 yourself; if 3 seem very important, you can vote for all 3”. Eleven ranked Ideas were forthcoming. The top three included: 6 Find an AUD/SLP on the home page - make link more prominent 6 Complaints should be more apparent 6 Be able to find an audiologist or SLP near me (via distance; map) Ranking Close 2nd: 4 Search function should be more user friendly These key points were echoed in the Survey Monkey Results (13 responses).

NEXT STEPS

1) Key themes will be identified - for example, prominence of the Public Register on the website, alerting the public to conduct information, ensuring conduct information is understandable and improving Public Register navigation. Research will be carried out, primarily by reviewing other regulatory colleges’ websites and public registers for ideas to improve identified areas of concern.

2) The Practice Advice team will meet with Baron French, Director of Information Technology, to discuss the key themes and specific recommendations and to make changes to the Public Register, if appropriate.

CASLPO●OAOO Page 2 of 3

3) The Practice Advice team will embark on the second phase of the project and recruit the patient/family group to evaluate the Public Register.

Marketing of the public register by Lisa Gibson will continue to increase public awareness and informed decision making about the two regulated professions and conduct information.

CASLPO●OAOO Page 3 of 3 REPORT TO COUNCIL EXECUTIVE COMMITTEE

MEETING DATE May 24, 2019 REPORT DATE May 27, 2019

The Executive Committee monitors and coordinates the work of the committees of Council and ensures that Council has all the pertinent information that it requires prior to making decisions. The Committee recommends the composition of all committees for the upcoming cycle of Council meetings and develops the schedule of Council meeting dates. The Committee deals extensively with matters concerning external relations involving the Ontario Association of Speech-Language Pathologists and Audiologists (OSLA), Canadian Alliance of Audiology and Speech-Language Pathology Regulators (CAASPR) and the Federation of Health Regulatory Colleges of Ontario (FHRCO). The Committee develops program concepts for Council learning development enhancements, and has a particular focus on governance matters and transparency and accountability initiatives. The Committee completes a formal annual performance appraisal of the Registrar.

The Executive Committee met on May 24, 2019.

1. Registrar Goals for 2019 An in-camera session to review the Registrar’s mid-year annual performance goals for 2019 was held.

2. Evaluation of March 1 Council Meeting Feedback from the 14 Council members who completed the survey was very positive. There were no recommendations to Council from the Committee in response to comments.

3. Registrar’s Report The Registrar highlighted that:

• R. Cimerman and L. Bartolini (H&S Rep) are developing a new Health and Safety Program. A certified H&S Consultant has been contracted for 3 months to bring CASLPO up-to-date with all legislated requirements as per the Workplace Health and Safety Act of Ontario including mandatory training for all staff, updated H&S Board, risk assessment, workplace inspection report training and updated policies.

4. CAASPR A full day Executive Committee meeting took place on March 18 with the sole focus of understanding CAASPR issues and making recommendations to the CAASPR President by submitting a letter from the President (attached). Some progress is being made at the Registrar’s Committee table with discussions taking place re CAASPR fee increases and hiring an Executive Director.

5. FHRCO Update FHRCO Highlights publication was shared (attached). Cayton Report – also sent to CAASPR for discussion at the June Board meeting (attached). FHRCO Governance Survey (attached). – interesting results showing a split of opinion in different areas of governance among the 26 colleges.

6. 25th Anniversary – (Presentation attached)

7. Non-Council Member Appointment P. Singh put forward a request for the appointment of S. Singbeil to ICRC as there is a shortage of members due to 2 recent vacancies. The Committee approved the appointment. Another request for appointment is expected in the next several months.

8. Strategic Planning C. Bock reported strategic goals are on track.

9. 2017-2018 Annual Report Several revisions were recommended. If time does not allow for the redesign of the Report, the recommendations will be implemented for the 2018-2019 report.

10. Motions to Council for approval/affirmation: The Executive Committee recommends the following be approved by Council: • Position Statement on Professional Boundaries • Sexual Abuse Prevention Program • Risk Management Program • 2017-2018 Annual Report

EXECUTIVE COMMITTEE MEMBERS

T. D’Agnillo, SLP-Interim President/Chair, J. Anderson, AUD-Vice President, V. Vaillancourt, M. Moussa-Elaraby, R. Penny

REPORT TO COUNCIL REGISTRATION COMMITTEE

MEETING DATE June 6, 2019 REPORT DATE May 28, 2019

The Registration Committee provides a fair and transparent process for reviewing and deciding on applications for registration in accordance with the Regulated Health Professions Act, College regulations, and matters that have been referred to it by the Registrar where the Registrar: (a) has doubts, on reasonable grounds, about whether the applicant fulfills the registration requirements; (b) is of the opinion that terms, conditions or limitations should be imposed on a certificate of registration of the applicant and the applicant does not consent to the imposition; or (c) proposes to refuse the application.

The Committee also advises Council and makes recommendations on matters relating to entry to practice standards, registration regulations, and related matters. It also addresses issues of reporting practices concerning Ontario’s Office of the Fairness Commissioner.

On March 7, 2019, the Registration Committee met face-to-face. • The Committee approved a more streamlined process for the review and approval of coursework and practicum proposals that allows for staff to evaluate the course and practicum suitability. • During this meeting, 17 application cases were also considered.

On May 15, 2019, a panel of the Registration Committee met to review one application case.

APPLICATION CASES The following application cases were reviewed at the above-mentioned meetings:

Profession No. of Cases Type Decision Audiology 2 International applications Applications approved with terms, conditions, and limitations. 1 Coursework/Practicum Proposals approved. Proposal Speech-Language 1 Canadian application Application approved with Pathology terms, conditions, and limitations. 2 International applications Applications approved. 3 International applications Applications approved with terms, conditions, and limitations. 1 Non-Practising members Application approved with applying for a General terms, conditions, and certificate limitations.

Page 1

APPLICATION CASES continued…

Profession No. of Cases Type Decision Speech-Language 5 Coursework/Practicum Proposal approved with a Pathology Proposal condition. 2 Application to modify or Previous decision modified remove terms, conditions, and limitations 1 Application reconsidered Previous decision modified due to title infringement matter arising before registration TOTAL 18

COMMITTEE MEMBERS:

Yvonne Wyndham (Chair); Jennifer Anderson; Tina D’Agnillo; Lynn Ellwood; Elizabeth Fitzpatrick; Melanie Mousa-Elaraby; Pam Millett; and Shari Wilson.

Page 2 REPORT TO COUNCIL

QUALITY ASSURANCE COMMITTEE FROM Alexandra Carling, Director of Professional Practice & QA MEETING DATE June 6th 2019

REPORT DATE May 27th 2019

Quality Assurance is a statutory committee mandated to promote, maintain and evaluate continuing competence among members, and to ensure the quality of practice of the professions in accordance with the legislation, regulations, standards, guidelines and policies of the College, thereby protecting the public.

The Quality Assurance (QA) committee met in person on March 4th, 2019.

1) SELF-ASSESSMENT TOOL 2019 SUBMISSION

The Quality Assurance Committee (QAC) made decisions about those members who failed to submit their SAT on time. One member was required to participate in peer assessment in accordance with the QA regulation.

2) SELF-ASSESSMENT TOOL 2020 SUBMISSION

Four additional indicators will be added to the 2020 SAT reflecting new standards and content of documents and processes. The indicators will address conflict of interest, advertising, clinical reasoning and professionalism. One indicator regarding continuous learning will be removed as two sections of the SAT address learning goals and continuous learning.

3) CLINICAL REASONING TOOL (CRT): REMEDIATION PROGRAM

The Committee reviewed the CTR remediation program and participated in remediation exercises. This program is available to the QAC as part of a Specified Continuing Education or Remediation Program (SCERP) should a member be found to have inadequate clinical reasoning.

4) PEER ASSESSMENT 2019: ON SITE PEER COACHING

The committee reviewed the onsite remediation process and the educational module

QUALITY ASSURANCE COMMITTEE MEMBERS: Tina D’Agnillo (chair), Satpaul Singh Johal, Donna Mooney, Jennifer Anderson, Yvonne Wyndham, Lynn Elwood, Shanda Hunter-Trottier (non-council professional) and Joan Steinsky (non-council professional).

REPORT TO COUNCIL

INQUIRIES, COMPLAINTS AND REPORTS COMMITTEE (ICRC)

MEETING DATE June 6, 2019 REPORT DATE May 28, 2019

The Inquiries, Complaints and Reports Committee (ICRC) is the statutory committee that considers all complaints and reports made to the College regarding members. The ICRC acts as a screening committee and has the responsibility to determine whether or not allegations warrant a referral to the Discipline Committee for a hearing. If a referral is not merited in a particular case, the ICRC may make other decisions in accordance with the legislation.

Operationally, the ICRC meets by way of two standing panels to deal with cases, with respective panels maintained for each profession. The full committee meets for purposes of training and policy deliberation.

CASE STATUS UPDATE

There are currently 159 open cases on the ICRC roster.1 Open cases are those where a decision has not yet been sent to the member. One (1) of the cases involves a matter pre-dating 2015. Fourteen (14) of the cases involve matters originating in 2015, from the same complainant. There are five (5) open cases from 2017: one (1) complaint, three (3) reports and one (1) incapacity matter. There are twelve (12) open cases from 2018: five (5) complaints, four (4) reports and three (3) incapacity matters. One Hundred and twenty- six (126) new complaint cases began in 2019: one hundred and eighteen (118) of which are from the same complainant.

The case opened prior to 2015, began in 2013 and is an incapacity inquiry. In the incapacity inquiry, the member’s certificate of registration has been suspended pending completion of an independent medical assessment.

Since the last report to Council, the ICRC has closed and delivered its written decision in five (5) cases and has rendered decisions in six (6) other cases. The decisions for these six cases are currently being drafted.

1 The numbers in this report only include received complaints and matters where an investigator has been appointed. Other matters are dealt with informally through the Professional Conduct department and are reported to the ICRC when a resolution cannot be achieved.

Breakdown of Open Cases by Profession Complaints: Audiology 126 (2019-121 cases; 2018-4 cases; 2017‐1 case) Speech‐Language Pathology 21 (2019-5 cases; 2018‐2 cases; 2015‐14 cases) Registrar’s Reports: Audiology 4 (2018‐1 case; 2017‐ 3 cases) Speech‐Language Pathology 3 (2018‐ cases) Incapacity Inquiries: Audiology 1 (2013‐1 case) Speech‐Language Pathology 4 (2018-3 cases; 2017‐1 case)

Of the open cases, the three most prevalent areas of investigation involve conflict of interest (127 cases); advertising (123 cases); and billing involving a third-party payer (18 cases). It is important to note that the majority of these cases relate to the same complainant. Further, as noted in the last report, the College has received an unprecedented number of advertising complaints, a total of 118 complaints, from the same party.

ICRC PANEL AND COMMITTEE MEETINGS SINCE FEBRUARY 21, 2019 (DATE LAST REPORT FOR COUNCIL WAS PREPARED)

The AUD Panel met on March 29, 2019 and April 15, 2019 to review 4 cases. The panel also met on May 21, 2019 and rendered 2 decisions. The AUD panel is scheduled to meet on June 25 and August 26, 2019 to review and dispose of cases which are ready for disposition. The SLP panel met on both April 1 and May 7, 2019 and rendered 2 decisions. The SLP panel is scheduled to meet on June 11, July 8 and August 12, 2019 to review and dispose of cases.

HEALTH PROFESSIONS APPEAL AND REVIEW BOARD (HPARB)

One (1) ICRC decision is under review by the Board, which began on May 24, 2018. The College attended the pre‐review conference on October 2, 2018. The case review is scheduled for May 29, 2019.

The above review was initiated by the complainant. COMMITTEE MEMBERS Shari Wilson, Public Member (Chair) Josée Lagace, AUD Non-Council (resigned Melanie Moussa-Elaraby, Public Member January 8, 2018)Deb Zelisko, AUD Non-Coucil Bob Kroll, SLP Member (term end May 16, 2019)

REPORT TO COUNCIL

FINANCE COMMITTEE FROM Ruth Cimerman MEETING DATE June 6, 2019

REPORT DATE May 30, 2019

The Finance Committee is a non-statutory committee with a mandate to review all matters with a financial impact on the College. It prepares recommendations to Council on the budget, risk management and the audit.

The Finance Committee in person on May 14, 2019 and considered the following items.

1) REVIEW OF YTD Q2 2019 FINANCIAL RESULTS

Staff reviewed the Q2 Year-To-Date March 31, 2019 Financial Report and summarized the overall financial picture. The following areas were highlighted: • Overall, we are at $200k Net Profit which is $8K lower than budgeted. • Revenue is $22K higher than budgeted due to fewer resignations, fewer status changes to non-practicing, more late fees and higher return rates on investments than expected. • Total expenses are $30K higher than budgeted due to larger than expected legal expenses required for CAASPR.

2) 2018-19 CASLPO OPERATIONAL PLAN

Staff presented the 2018-19 Operational Plan and the approach CASLPO took with its creation. The Committee felt that the plan was aligned with CASLPO’s Strategic Plan goals and CASLPO Success Pillars. The Committee recommended that during the presentation to Council, staff should focus on the operational projects rather than the Strategic Plan projects because operational projects are under the purview of the Registrar and have therefore not been presented to Council to date.

3) REVIEW OF PROCESS AND TIMELINES FOR THE OPERATIONAL PLAN AND BUDGET

Staff briefly outlined the process for the development of the Budget and strategic and operational projects. Staff communicated that the process was consistent with the previous year.

The Committee was comfortable with the process.

4) REVIEW OF CASLPO FINANCIAL PLANNING PRINCIPLES

Staff reminded the Committee that the Financial Planning Principles are formally reviewed every 3 years and a formal review was completed in 2017. The document was provided to the Committee for information purposes only.

5) RISK MANAGEMENT

The Committee performed their annual review of the documents which comprise the Risk Management Plan (i.e. Risk Policy, Risk Tolerance Profile, Risk Register and Fraud Risk Reassessment Checklist). The Committee made the following motions: 1) Risk Policy • To recommend that Council approve the Risk Policy. 2) Risk Tolerance Profile • To recommend that Council approve the revised Risk Tolerance Profile. 3) Risk Register • To recommend that Council approve CASLPO’s focus on the highlighted items from the Risk Register. Selection was based on: i. Risk tolerance rating; ii. Significant changes to risks or mitigation since the last review; and iii. new emerging risks that need to be addressed • These selected items will appear as an appendix to the Risk Tolerance Profile 4) Fraud Risk Reassessment Checklist • To present the highlighted risk from the Fraud Risk Reassessment Checklist as an appendix to the Risk Tolerance Profile.

6) AUDITOR ASSESSMENT TOOL

At the January 9, 2019 Finance Committee meeting, staff brought forward the idea of creating a more robust evaluation tool for the Committee to use during the reappointment process. Staff shared that other Colleges have already created tools for their use and could provide guidance. The proposed Assessment Tool is based on tools and templates provided by the Chartered Professional Accountants of Canada (CPA) and feedback from other Colleges regarding their practical use. The Committee thought the tool addressed their requests for a methodical and consistent approach to assessing the auditors and improving their ability to provide meaningful recommendations to Council for auditor reappointments. The Committee passed a motion to recommend that Council pilot the assessment tool for the 2018-19 audit process. The Committee will provide a report to Council using the results of

the assessment tool for the next fiscal year. The report will support the recommendations that Finance Committee will make to Council regarding reappointment of the auditors.

5) REAPPOINTMENT OF AUDITOR

In order to pilot the Auditor Assessment Tool for the 2018-19 audit, the Committee recommends that Council reappoint Hilborn as CASLPO auditors. In the next fiscal year, Council will base their decision for reappointment of the auditor on the report provided by the Finance Committee using the Auditor Assessment Tool.

REPORT TO COUNCIL

PRACTICE MATTERS COMMITTEE

MEETING DATE June 6th 2019

REPORT DATE May 24th 2019

The Practice Matters Committee (PMC)) is a non-statutory standing committee which provides advice to Council on matters affecting speech-language pathologists and audiologists and the practice of speech-language pathology and audiology.

The PMC met for a half day in-person meeting on April 25th, 2019.

1. ELECTION OF CHAIR

Lynn Ellwood was nominated and acclaimed as chair of the PMC.

2. ORIENTATION

The PMC was orientated to the committee’s terms of reference, conflict of interest and bias, and the history of how the PMC came into being.

3. CRITERIA AND TRACKING

A proposed set of weighted criteria was agreed upon by the committee to prioritize and select standards and documents for development or revision. Criteria include, risk of harm, quality assurance and professional conduct concerns, evidence-based practice concerns, uncertainty regarding area of practice and continued relevance. The Committee members and staff will provide input regarding emerging issues, trends and document relevance for consideration on an ongoing basis, which will be added to a table with dates and possible actions. This table will be a standing item on the agenda and will serve to track issues discussed at PMC meetings over time.

PRACTICE MATTERS COMMITTEE MEMBERS: Lynn Ellwood (chair), Donna Mooney, Ruth Ann Penny, Yvonne Wyndham, Elizabeth Fitzpatrick, Tara Barber, Kim Eskritt, Véronique Vaillancourt, Stella Ng (non-council professional) and Jimena Torres Valencia (non-council professional)

REPORT TO COUNCIL

PATIENT RELATIONS COMMITTEE FROM Brian O’Riordan/Lisa Gibson MEETING DATE June 6, 2019 REPORT DATE May 9, 2019

This committee’s primary duty is to establish a patient relations program, which includes a sexual abuse prevention plan and making recommendations about the amount of funding the College commits to assist victims of sexual abuse by members. The Committee also oversees initiatives relating to public education and awareness.

SUMMARY

The Patient Relations Committee met on April 29, 2019.

1. The Committee reviewed CASLPO’s Sexual Abuse Prevention Plan (SAPP) documentation including revisions to 2 components:

 Sexual Abuse Prevention Program  Position Statement on Professional Relationships and Boundaries

P. Singh reminded the Committee that it had approved initial revisions to the Sexual Abuse Prevention Plan (SAPP) on January 22 and 29, 2019. As directed, the revised SAPP was provided to the Inquiries, Complaints, Reports Committee (ICRC) for input. The SAPP now before the Committee incorporates comments from the ICRC as well as further revisions, as requested at the Committee’s last meeting.

P. Singh shared that ICRC found the SAPP to be clear and easy to understand, given the complexity of the law. ICRC also suggested that FAQs and an ex.press eNewsletter article discuss the restriction respecting spousal treatment.

In terms of item 13 of the SAPP (‘Mandatory Reports’), the Committee agreed that reference to additional mandatory requirements under the Child, Youth and Family Services Act be included as a footnote because it did relate to sexual abuse of a patient by a health care provider, and was an important additional duty to note. Further, the Committee agreed that, as noted in the Health Professions Procedural Code, where a member did not know the name of the alleged health care abuser and did not then need to make a report, this information be included in the “Contact the College” section.

P. Singh reminded the Committee that the Position Statement on Professional Boundaries has been updated to reflect the recent legislative changes, and additionally, to enable the document to be more user friendly for public consumption.

P. Singh also noted that the document incorporated feedback from the ICRC, following the Committee’s request for feedback. The ICRC found the documents to be clear and understandable. It was noted that the Position Statement being reviewed also included all changes from the January Patient Relations meeting.

After fulsome discussion and consensus for a few changes the Patient Relations Committee made a motion to bring both the Sexual Abuse Prevention Program and Position Statement on Professional Relationships and Boundaries to Council for approval and publication.

2. Other Business – CASLPO 25th Anniversary – Grants for Patient Advocacy Groups B. O’Riordan shared that progress has been made following January’s Patient Relations Committee meeting input. Two organizations have been identified and an update will be shared once those organizations have responded.

B. O’Riordan, reminded the Committee that he forwarded to CASLPO Council a recently published report on BC College of Dental Surgeons and the BC Health Professions Act by Sir Harry Cayton of the UK Public Standards Authority. The underlying importance of the Patient Relations Committee as a statutory obligation was emphasized in the report.

PATIENT RELATIONS COMMITTEE MEMBERS

Shari Wilson (Chair), Tara Barber, Karen Bright, Kim Eskritt, Donna Mooney, Stella Ng, Véronique Vaillancourt